Corporate Counsel – Payor Contracting and Payor Disputes

Providence•Irvine, CA

About The Position

Description The Role The Corporate Counsel position is responsible, under the guidance of Department of Legal Affairs (DLA) Leadership, for supporting Providence’s integrated delivery system by providing legal advice and strategic guidance on providing legal advice and strategic guidance on payor relationships, reimbursement disputes, and providing legal advice to the Providence Clinical Network. This role partners closely with Revenue Cycle, Managed Care, Finance, and Clinical leadership to address complex legal, regulatory, and contractual issues impacting reimbursement, access, and care delivery. This attorney will play a critical role in supporting Providence’s payor contracting strategy, managing payor disputes and litigation, and advising on legal issues affecting Providence’s clinical network. Key Position Responsibilities: Payor Contracting & Reimbursement Support: Provide legal advice on payor contracting matters, including interpretation, negotiation, and dispute resolution related to commercial, Medicare Advantage, and Medicaid managed care agreements. Advise on reimbursement methodologies, payment terms, audit rights, dispute resolution provisions, limitations of liability, and risk allocation in payor agreements. Partner with Revenue Cycle and Finance teams to support payor strategy and escalation of contract performance issues. Payor Dispute and Litigation Support: Lead or support payor disputes involving underpayment, nonpayment, recoupments, audits, and reimbursement methodology challenges. Manage and coordinate outside counsel in payor-related litigation, arbitration, and regulatory proceedings. Develop litigation and settlement strategies in collaboration with internal stakeholders, including executive leadership. Translate complex legal and reimbursement issues into clear, decision-ready guidance for senior leaders. Providence Clinical Network: Provide legal support to Providence's employed and affiliated clinical networks, including issues related to network participation, alignment structures, and care delivery models. Advise on regulatory and contractual issues affecting physician groups, clinically integrated networks, and value-based arrangements. Regulatory & Compliance Advisory: Advise on healthcare regulatory requirements impacting payor relationships and reimbursement, including state and federal healthcare laws and regulations. Cross-Functional Partnership & Leadership: Serve as a trusted legal advisor to operational, financial, and clinical leaders across the organization. Work collaboratively with other attorneys and legal professionals within DLA. Support development of internal processes, playbooks, and escalation pathways related to payor disputes and contracting issues. Qualifications Juris Doctor degree from an accredited law school. Active admission and license to practice law in either California or Washington. At least 7-10 years of relevant legal experience, with a focus on healthcare, payor contracting, reimbursement, or complex healthcare disputes. Experience advising healthcare systems, hospitals, physician groups, or managed care organizations strongly preferred. Demonstrated experience handling complex reimbursement disputes, litigation, or arbitration matters. Strong understanding of healthcare reimbursement structures, payor-provider relationships, and clinical operations. Ability to synthesize complex legal, financial, and operational issues and provide practical, business-oriented advice. Excellent written and verbal communication skills, with experience advising senior executives. Proven ability to work independently while managing multiple priorities in a fast-paced, matrixed environment. Ability to work collaboratively with attorneys and staff within DLA and Providence.

Requirements

Juris Doctor degree from an accredited law school.
Active admission and license to practice law in either California or Washington.
At least 7-10 years of relevant legal experience, with a focus on healthcare, payor contracting, reimbursement, or complex healthcare disputes.
Strong understanding of healthcare reimbursement structures, payor-provider relationships, and clinical operations.
Ability to synthesize complex legal, financial, and operational issues and provide practical, business-oriented advice.
Excellent written and verbal communication skills, with experience advising senior executives.
Proven ability to work independently while managing multiple priorities in a fast-paced, matrixed environment.
Ability to work collaboratively with attorneys and staff within DLA and Providence.

Nice To Haves

Experience advising healthcare systems, hospitals, physician groups, or managed care organizations strongly preferred.
Demonstrated experience handling complex reimbursement disputes, litigation, or arbitration matters.

Responsibilities

Provide legal advice on payor contracting matters, including interpretation, negotiation, and dispute resolution related to commercial, Medicare Advantage, and Medicaid managed care agreements.
Advise on reimbursement methodologies, payment terms, audit rights, dispute resolution provisions, limitations of liability, and risk allocation in payor agreements.
Partner with Revenue Cycle and Finance teams to support payor strategy and escalation of contract performance issues.
Lead or support payor disputes involving underpayment, nonpayment, recoupments, audits, and reimbursement methodology challenges.
Manage and coordinate outside counsel in payor-related litigation, arbitration, and regulatory proceedings.
Develop litigation and settlement strategies in collaboration with internal stakeholders, including executive leadership.
Translate complex legal and reimbursement issues into clear, decision-ready guidance for senior leaders.
Provide legal support to Providence's employed and affiliated clinical networks, including issues related to network participation, alignment structures, and care delivery models.
Advise on regulatory and contractual issues affecting physician groups, clinically integrated networks, and value-based arrangements.
Advise on healthcare regulatory requirements impacting payor relationships and reimbursement, including state and federal healthcare laws and regulations.
Serve as a trusted legal advisor to operational, financial, and clinical leaders across the organization.
Work collaboratively with other attorneys and legal professionals within DLA.
Support development of internal processes, playbooks, and escalation pathways related to payor disputes and contracting issues.