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Legal Analyst, Fairfield, CA


Organization: Partnership HealthPlan of California
Category: Professional
Location: Fairfield, CA
Date Job Posted: June 30, 2021
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Legal Analyst

Job ID 2021-1889 FLSA Status Exempt

Overview

Under general supervision of the Director of Legal Affairs, provides paralegal and legal analytical support to legal counsel; and other related work to support the Health Plan’s Legal Department

Responsibilities

Manage and handle projects assigned by the Director of Legal Affairs legal expertise, including:

  • Manage subpoena, third party liability and medical records requests, including reviewing
  • records provided by internal departments prior to their release.
  • Conduct legal research and analysis of relevant state and federal statutes and regulations, contractual provisions, and waivers with which the health plan must comply.
  • Research, analyze, and evaluate new or pending state and federal legislation to determine impact on products, policies, or procedures.
  • Prepare written summaries related to new and existing laws and regulations.
  • Provide analysis and support for public agency requirements. Participate in the review and production of Public Records requests.
  • Independently conduct legal, regulatory, and other healthcare related research on a wide variety of issues and draft written findings.
  • Coordinate and support the Legal Affairs Department review and assessment of vendor contracts including assessment of compliance with Federal and State Privacy laws and regulations.
  • Collaborates with contracting team to complete timely review of vendor contracts.
  • Develop and support implementation of organization’s privacy policies, procedures, and guidelines in compliance with federal and state laws.
  • Analyze and respond to department inquiries regarding contractual or regulatory requirements. Review and analyze state and federal regulations related to grievances and appeals by members. Provide legal analysis and support to health plan’s Grievance unit.
  • Analyze and respond to member services requests for Authorized Representative / Personal Representative documentation review to insure legal authority is valid.
  • Supports the Director of Legal Affairs and colleagues as needed.
  • Serve as a resource for Provider Contract Template to ensure consistency with Federal and State laws and regulations.
  • Provide support for coordination of outside legal counsel activities.
  • Other duties as assigned by the Director of Legal Affairs, within the general scope of the position.

Qualifications

Education and Experience

Bachelor’s Degree in related field; three – four (3-4) years of experience in the health care field, preferably MediCal managed care with specialized knowledge in Administrative Law, Medicaid, and State healthcare programs; Title 22 and Knox Keene preferred; or equivalent combination of education and experience.

Special Skills, Licenses and Certifications

ABA approved Paralegal Certification or current enrollment in a paralegal program and ability to obtain Paralegal Certification with 12 months required. Ability to conduct legal research utilizing online tools such as Westlaw or LexisNexis. Highly proficient in applicable business software applications using PC usage, Microsoft Word, PowerPoint, Excel, Adobe Acrobat, typing speed of 45 wpm. Valid California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business.

Performance Based Competencies

Excellent oral and written communication skills. Strong organizational skills with ability to prioritize assignments. Excellent drafting, editing, and proof-reading skills, including legal writing, grammar, spelling, and composition. Must work well under pressure with frequent interruptions and shifting priorities. Ability to communicate concepts clearly and concisely. Ability to exercise discretion and independent judgment. Must be able to handle multiple tasks and meet deadlines.

Work Environment And Physical Demands

Ability to use a computer keyboard and other business machines. More than 50% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 35 lbs

All HealthPlan employees are expected to:

  • Provide the highest possible level of service to clients;
  • Promote teamwork and cooperative effort among employees;
  • Maintain safe practices; and
  • Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change

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