Associate General Counsel - Payer Contracting

WVU Medicine

About The Position

Under the supervision of the Chief Legal Officer or designee, the Associate General Counsel provides day-to-day legal advice and counsel concerning contracts between West Virginia United Health System, Inc., the West Virginia University clinical practice plan, and commercial health insurance plans, government-sponsored health plans, managed care organizations, and other third-party payers. The role drafts, negotiates, and reviews agreements involving managed care, reimbursement, provider networks, value-based care, accountable care, delegation, credentialing, and other payer arrangements. It also advises managed care, finance, and revenue cycle teams on reimbursement arrangements, contract performance, and payer disputes, including issues involving contract interpretation, reimbursement, denials, audits, and underpayments. Other duties may be assigned by the Chief Legal Officer, Deputy General Counsel, or their designees. The position provides legal guidance on strategic partnerships, network participation, provider affiliations, population health arrangements, corporate governance, and regulatory compliance. It develops agreement submission and review procedures and template agreements, coordinates with outside counsel when proceedings arise, and oversees and supports assistant general counsel and other legal services personnel. Remote and/or hybrid work is considered. The position is based in a general office work environment.

Requirements

Juris Doctor degree.
Membership in the West Virginia Bar or eligibility for membership.
Ten years of substantial experience in a law firm or in-house legal department in corporate, contract, and regulatory law.
Excellent organizational and interpersonal skills.
Excellent verbal and written communication skills.
Ability to manage multiple tasks simultaneously.
Ability to work under stress and meet short deadlines.
Ability to solve problems in a timely and practical manner.
Knowledge of laws and regulations applicable to health insurers, payers, and managed care companies.
Knowledge of litigation processes and procedures.
Knowledge of the general operations of nonprofit and for-profit corporations, limited liability companies, and joint ventures.

Nice To Haves

Experience drafting, reviewing, and negotiating contracts.
Experience negotiating and advising on healthcare payer contracts and managed care contracting.
Experience working within a health system, academic medical center, or healthcare provider organization.
Knowledge of laws and regulations applicable to hospitals and professional providers.

Responsibilities

Prepare, review, and assist in negotiating managed care, reimbursement, provider network, value-based care, accountable care, delegation, credentialing, and other payer agreements.
Provide legal guidance to management on strategic partnerships, network participation initiatives, provider affiliations, and population health arrangements.
Advise payer contracting, finance, and revenue cycle teams on compliance, legal guidelines, and contracting matters.
Oversee and provide legal advice on corporate governance matters involving accountable care organizations and provider credentialing entities.
Keep current on legal trends, particularly fraud and abuse, Stark, compliance, and regulatory matters.
Monitor legal trends and standards governing contracts between healthcare providers and payers and help ensure compliance.
Coordinate with outside counsel in litigation, arbitration, mediation, or regulatory proceedings.
Develop policies and procedures for agreement submission and review, and draft and update template agreements for payer contracting teams.
Respond promptly to requests for advice or information.
Prepare and review agreements with commercial insurers, Medicare Advantage plans, Medicaid managed care organizations, and other third-party payers.
Promote respectful and safe treatment of patients, families, visitors, and personnel, and contribute positively to departmental relationships.
Maintain attendance and punctuality and contribute to departmental and organizational goals.
Address the Organizations’ legal needs diligently, responsibly, and in a timely manner.
Oversee assistant general counsel and/or other legal services personnel and staff, providing support and training.
Provide backup coverage for the Deputy General Counsel, Chief Legal Officer, or their designees as needed.