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AdventHealth Denials Management Legal Advisor in Altamonte Springs, Florida


Denials Management Legal Advisor AdventHealth Corporate

Location Address: 2600 Lucien Way, Maitland, FL 32751

Top Reasons To Work At AdventHealth Corporate

  • Great benefits

  • Immediate Health Insurance Coverage

  • Career growth and advancement potential

Work Hours/Shift:

  • Full-Time, Monday – Friday

You Will Be Responsible For:

  • Reviews denials data and collaborates with Physician Advisors, denials management staff, patient financial services, utilization review, managed care, and other appropriate teams to identify and remediate identified problem areas in reimbursement and denials.

  • Communicates regularly with appropriate stakeholders to address reimbursement and denial issues and collects and prepares necessary documentation for legal action.

  • Represents AHS in legal disputes with payers to receive proper reimbursement for services rendered.

  • Utilizes medical documentation provided by clinical counterparts, business rationale from billing/finance and other departments, and payer contracts & policies to provide accurate clinical and legal justification to combat denial and underpayment disputes.

  • Communicates with payer representatives and provides them necessary documents in a timely manner when resolving disputes.


What You Will Need:

  • Juris Doctor degree from an ABA-approved law school

  • Minimum of 10 years of health care contract experience

  • Minimum of 7 years of leadership experience

  • Active membership and good standing of the Bar

  • Licensed to practice law in the state of Florida and other states with AHS entities

  • Proficient understanding of U.S. health services systems and healthcare legislation

  • Proficient understanding of contract law

Job Summary:

Under general supervision of the Executive Director of Denials Management, the Legal Advisor will handle large-scale patterns of denials and reimbursement issues through legal action to ensure appropriate reimbursement for the medical services provided by Adventist Health System. This role involves working with other departments within the denials management team to identify payment issues and collect necessary evidence. The Legal Advisor will act as a liaison between AHS and payers, resolving issues through direct communication with payer representatives and legal counsel, and representing the interests of AHS in such disputes. This position requires navigating state and national health law frameworks and payer contracts, and leveraging interpretation of policies to support appeals with medical need and legal justification, to ultimately maximize revenue realization. Adheres to AHS Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.