Legal Specialist - Springfield, United States - Health New England

Description

Job Description

SUMMARY: The Legal Specialist performs a combination of functions shown below based on the needs of the Legal department and the company, and will assist the Staff Attorney, the Assistant General Counsel, the VP/General Counsel, and other key stakeholders.

ESSENTIAL FUNCTIONS:

Contract /Document Creation, Preparation and Management – 30%

• Prepares, manages and tracks contracts, amendments and contract issues
• Assists in the creation and preparation of standard contracts.
• Evaluates business needs of stakeholders and form opinions regarding contracting best practices. Make recommendations for and assist attorneys and other stakeholders with contract negotiations and contract modifications
• Drafts and prepares other documents, such as correspondence and filings, as required.
• Prepares form agreements, such as confidentiality and business associate agreements, for attorney review.
• Reviews contracts for consistency with state managed care and NCQA requirements. Make recommendations to ensure compliance.
• Reviews and prepares correspondence and communications relating to contracts and associated documents.
• Conducts intake interviews of stakeholders to determine, evaluate and identify underlying needs, and understand the business impact of, contracts. Prepares summaries for attorney review. Educate non-legal stakeholders on contract issues.
• Creates and implements Company-wide contract routing process by evaluating and determining best practices to help in the awareness of location, nearness to completion and turnaround time of contracts. Manages HNE's iContracts system and update system with current information.
• Responds to department managers' questions about contract terms. Form opinions regarding best practices in assisting department managers with contracting processes.
• Works with the Communications Department to insure all member agreements and member documents comply with all legal requirements. Makes recommendations to implement compliance.
• Maintains hard copies and e-files (Cypress and SharePoint) of legal documents. Maintain SharePoint Legal site and Legal OFI database.
• Assists with the continued development of processes and systems related to contract review and management.
• Proofreads documents and understands and identify trademark and copyright issues.

Organize and direct Massachusetts Association of Health Plans (MAHP) communications – 30%

• Assists attorneys by coordinating emails and communication related to MAHP's legislative and regulatory agenda
• Understands and prioritizes daily communications regarding complex legislative issues, triages requests from MAHP, and identify appropriate respondent from HNE
• Ensures timely responses to MAHP communications and requests. As required, identify key stakeholders and coordinate appropriate responses. Provides guidance to key stakeholders as needed.

Coordinates responses to state and federal government agencies (including the MA Division of Insurance, MA Attorney General's Office, MA Office of Patient Protection, Department of Health and Human Services, etc.) – 15%

• Coordinates filings with DOI (HMO Holding Company) and OPP (Annual report) to ensure accurate and timely submission. Responds to government agencies' questions regarding filings.
• Assists with ad hoc legal responses to government agencies including Department of Labor Subpoenas, Civil Investigative Demands (CIDs), and Requests for Proposals, (RFPs).
• Ensures timely responses to government inquiries, CIDs and RFPs by identifying key stakeholders and coordinating appropriate responses.
• Assists and works with outside counsel in the preparation of discovery requests and state and federal CIDs.

Reporting – 10%

• New York Health Care Reform Act (NYHCRA) surcharge reporting
• Evaluates and responds to requests from the State of New York health pools fund reporting web portal. Run reports through the web portal for updates on self-funded health plans as needed. Assists ASO groups with form filings and Third Party Administrator (TPA) elections. Assists ASO Account Representatives with any NYHCRA reporting requirements.
• SERFF-NAIC web portal – Serves as the key contact person for MA Division of Insurance (DOI) electronic filing system. Files form products electronically and coordinate responses to the DOI.
• HIOS/RBIS (Health Insurance Oversight System) – Upload filings as required by the federal government and federal healthcare reform requirements.

Filing/Recordkeeping – 10%

• Serves as Keeper of Medical Records for HNE, review requests to assure HIPAA compliance for members, and respond to subpoenas and other court orders and medical record requests from walk-in members.
• Maintains corporate insurance policies. Process corporate insurance renewal applications in a timely manner, including HMO Healthcare Portfolio, Errors & Omissions Liability, Directors and Officers Liability, Professional Lawyers, and auto insurance. Obtains certificates of insurance as required for general liability for leases and facility rental. Serves as the company contact for Baystate Health Risk Management.
• Maintains automobile insurance for company owned and leased vehicles. Process renewals with the RMV for all owned and leased vehicles. Files auto accident claims through closure of repair. Works with insurance agents, dealers, and leasing companies as needed.
• Assists HNE's Corporate Secretary with annual report filings for all HNE corporations.
• Reviews, coordinates, processes and maintains a database of class action lawsuits on behalf of HNE and ASO groups, including obtaining data from Healthcare Economics.
• Works with Accounting in the filing of Proofs of Claim on behalf of HNE in all bankruptcy matters. Prepares claim forms, receives attorney approval, and completes the task to the point of filing with United States Bankruptcy Court.
• Notifies and coordinates response with HNE's Accounting Department for all DOR or IRS Notices of Levy, and complete documents as required.
• Assist the sales department and the ASO account representatives with requests from employers and brokers. Maintains PHI Disclosure list for all brokers, and review annually the list of those authorized to receive PHI at self-funded health plans. Provides guidance to brokers as necessary regarding HIPAA and PHI.

Other – 5%

• Assists with other legal assignments as needed. Makes recommendations regarding litigation and license applications.
• Actively participates in Legal Department meetings and Opportunity for Improvement (OFI) meetings.
• Maintains legal subscriptions and the legal library. Regularly update regulatory binders.

MINIMUM REQUIREMENTS:

Bachelor's degree preferred and 4 years legal experience in a law firm, government agency or corporate legal department.

• Paralegal Certification or equivalent required
• Understanding of HMO business practices
• Excellent research, writing and communication skills
• Capable of rendering a concise opinion after doing the appropriate research
• Good problem solving skills
• Excellent word processing skills
• Ability to apply legal rules to practical daily operations
• Ability to prioritize assignments
• Ability to work well independently and with others
• Ability to work well with both internal and external customers
• Ability to lead teams as necessary
• Highly organized
• High attention to detail

WORKING CONDITIONS: Works in a standard office-based environment