Senior Counsel - Denials & Payor Litigation

Community Hospital•Grand Junction, CO

7d•Onsite

About The Position

Community Hospital is seeking an experienced Senior Counsel to provide strategic legal leadership in healthcare reimbursement, payer disputes, and revenue protection. The role addresses complex denials, underpayments, recoupments, audits, and payment disputes involving commercial insurers, government payers, third-party administrators, and other reimbursement entities. It works across law, finance, reimbursement, and hospital operations, partnering with Revenue Cycle, Patient Financial Services, Finance, Clinical Documentation, Coding, Compliance, Contracting, Medical Staff, and executive leadership. The Senior Counsel protects the hospital’s financial interests by identifying significant and systemic payer issues and developing legal strategies to maximize appropriate reimbursement. The role also leads or supports formal payer disputes and litigation and helps enforce payer contractual obligations, reduce preventable revenue loss, monitor recovery efforts, and report on litigation, financial exposure, and recovery opportunities. The position is on-site in Grand Junction, Colorado.

Requirements

Juris Doctor (J.D.) from an accredited law school.
Active license to practice law in Colorado or eligibility for admission; Colorado admission is required within six months of hire.
Five or more years of legal experience, preferably including significant healthcare contracting experience.
Experience negotiating complex commercial or healthcare agreements.
Strong understanding of healthcare regulatory requirements.

Nice To Haves

Experience working with a hospital, health system, academic medical center, or other healthcare organization.
Payer contracting experience.
Experience with physician arrangements and healthcare transactions.
Experience in healthcare and reimbursement law, payer disputes, litigation, denials and appeals, contract interpretation and enforcement, negotiation, regulatory compliance, financial and risk analysis, and executive-level communication.

Responsibilities

Provide legal counsel on complex and high-value hospital claim denials, underpayments, recoupments, payment delays, and other payer disputes.
Review and interpret payer contracts, reimbursement methodologies, applicable laws and regulations, and payer policies.
Develop strategies to recover unpaid, improperly denied, or underpaid claims.
Partner with Revenue Cycle and Finance to prioritize high-dollar and strategically significant reimbursement disputes.
Analyze denial and underpayment trends to identify systemic payer practices and recovery opportunities.
Advise executive leadership regarding financial exposure, recovery opportunities, and legal risk.
Lead or support litigation, arbitration, mediation, administrative proceedings, and other formal payer disputes.
Develop litigation strategy and draft or oversee legal documents.
Direct outside counsel when specialized expertise is needed and participate in legal proceedings.
Negotiate settlements and assess the legal and financial merits of potential actions.
Work with Revenue Cycle to determine when complex or high-value denials should be escalated beyond the traditional appeal process as legal disputes.
Interpret payer agreements and advise leadership regarding payment and enforcement rights.
Identify payer practices that may be inconsistent with negotiated contract terms.
Support enforcement related to reimbursement, timely payment, audits, recoupments, and dispute resolution.
Provide legal guidance during payer contract negotiations when reimbursement disputes or legal risks warrant involvement.
Recommend contract changes that may help reduce future denials and underpayments.
Develop strategies to reduce preventable revenue loss.
Monitor significant disputes and recovery efforts.
Prepare executive-level reporting regarding litigation, financial exposure, and recovery opportunities.