Supervising Paralegal & Provider Appeals Coordinator

LOCATION: Hybrid - incumbent will need to work in the Asheville, NC (Ridgefield) office at least one day a week, other days will be work from home. Incumbent must live within a reasonable commuting distance to Asheville, NC.

GENERAL STATEMENT OF JOB

This position reports to the Senior Associate General Counsel ("SAGC"). The Supervising Paralegal and Provider Appeals Coordinator ("Supervising Paralegal") exercises discretion and independent judgement regarding matters of significance, serving as the paralegal to the Legal Team and as the required BH/IDD Tailored Plan and Medicaid Direct PIHP Provider Appeals Coordinator. The Supervising Paralegal is responsible for providing high-level and moderate to complex administrative and paralegal support to the Legal Team. The Supervising Paralegal also provides support to other teams within Vaya Health's in-house Legal Department, upon request by the SAGC, or designee. This position is responsible for the supervision of the Legal Assistant. This position is also responsible for coordinating the provider appeals processes in compliance with federal and state laws and regulations, healthcare accreditation standards, and organizational policies, procedures, and business processes. This role is a hybrid position that is partially remote, incumbent will need to come into the office at least 1 day a week and on occasion more frequently depending on the need of the attorneys.

ESSENTIAL JOB FUNCTIONS

Legal Team Support Operations:
•  Litigation:
•  Assist attorneys with preparation for member and provider appeals, mediation conferences, administrative hearings and civil litigation in the North Carolina Office of Administrative Hearings and state and federal courts, including preparing, tracking, and filing of subpoenas, exhibits, tables of contents and of authorities; drafting pleadings, motions, affidavits, orders, briefs, and correspondence; drafting discovery requests and responses; and conducting legal research as needed.
•  Coordinate and schedule mediation and other case matters with other Vaya or subcontractor staff, opposing counsel, court or tribunal personnel, and others, when requested. Contact court clerks to ascertain legal procedures and local court rules when necessary.
•  Respond to calls or correspondences from member and their guardians on behalf of attorneys.
•  Organize evidence and schedule witnesses to appear at depositions and hearings; ensure that witnesses are ready when needed; and take courtroom notes. Assist attorneys in contacting other individuals as necessary to gather information relevant to cases and other projects.
•  Draft administrative and legal correspondence.
•  Proofread and check legal documents, citations, and authorities for accuracy and completeness.
•  Manage new and existing Legal Team case files by establishing and organizing electronic and physical files, updating the file tracking system, monitoring calendars, meeting deadlines, documenting actions, entering information into file databases and case management software, and confirming case status with attorney.
•  Provide support for collection activities, including but not limited to reviewing payment plans and notices of default, as well tracking, storing, and returning executed promissory notes.
•  Develop new litigation templates and improve existing ones.
•  Assist the Legal Department in responding to public records requests, medical records requests, and Medicaid Investigation Division requests as needed.
•  May be required to travel, occasionally, to attend court hearings, trials, and other activities to assist attorneys.
•  Transactional:
•  Draft contract templates, contracts, non-disclosure agreements, memorandums of understanding, scopes of work, amendments, assignments, and other agreements.
•  Oversee the storage, coordination, and tracking of contracts, as needed by the Contracts Team.
•  Work on assigned projects as needed to improve administrative and provider network contracting efficiency, data integrity, reports and tracking, communications, and other projects that impact the vendor management and contracting function of Vaya Health.
•  General Administrative Support:
•  Manage the Vaya's legal and compliance email account to ensure that the attorneys are responding to internal and external inquiries or to directly respond to such inquiries assigned to the Supervising Paralegal, and to complete monthly NCDHHS report.
•  Assist in developing, revising, and reviewing policies and procedures that are the responsibility of the Legal Department.
•  Develop, assist with, and oversee the writing and reviewing business processes within the Legal Department.
•  Complete other moderate to complex administrative assignments, including drafting correspondence and reports, scheduling and coordinating virtual, in-person, and telephone meetings and travel arrangements, maintaining electronic files and calendars, preparing reports, graphs, and PowerPoint presentations, and handling mail. Detailed attention to proofreading and formatting of all correspondence and written documents, with proper spelling and grammar, is required.
•  Provide administrative support to other committees as assigned, including, but not limited to, creating agendas, taking minutes, and tracking action items. Serve as backup to provide administrative support for other functions as assigned.
•  Communicate clearly and professionally in all formats (email, telephone, virtual, Teams, facsimile, etc.) with Vaya staff, subcontractors, providers, vendors, court officials, opposing counsel, Department representatives and other external individuals, as needed.
•  Provide other general paralegal and administrative support to the attorneys.
•  Perform, or oversee the performance of, other administrative tasks as assigned.
•  Supervision:
•  Oversee all Legal Team Support Operations, including oversight of performance of the Legal Assistant, with delegation of administrative responsibilities as appropriate. This includes assignment and delegation of applicable tasks, review of assignments for accuracy and timeliness, as well as monitoring workload as it relates to the delegated tasks.
•  Provide guidance and mentoring for continued professional development. Provider Appeals Coordination:
•  Serve as the Provider Appeals Coordinator, which is a mandatory Behavioral Health and Intellectual/ Developmental Disabilities Tailored Plan and Medicaid Direct PIHP position.
•  Serve as the backup provider appeals facilitator to the VP of Regulatory Affairs.
•  Coordinate and manage all plan-level and external provider appeals of health plan adverse actions or sanctions taken by Vaya, including for claims denial, overpayments, suspension of referrals, terminations, and other decisions in a timely manner.
•  Oversee and manage the provider appeals processes in compliance with federal and state laws and regulations, healthcare accreditation standards, and organizational policies, procedures, and business processes.
•  Understand and remain up to date on BH/IDD Tailored Plan and Medicaid Direct PIHP requirements pertaining to provider appeals processes.
•  Create new templates and update existing templates and business procedures that comply with the Tailored Plan and Medicaid Direct PIHP contracts with N.C. Department of Health and Human Services (NCDHHS), with statutory, regulatory, and accrediting body requirements, and with applicable internal policies and procedures.
•  Serve as the subject matter expert on the provider appeals processes in internal reviews by the Regulatory Compliance Team and external readiness and annual reviews by accreditation bodies and NCDHHS.
•  Assist SAGC in training staff on appeal timeframes for providers and assisting other departments in ensuring that the appeals forms accurately reflect the correct appeal timeframe.
•  Work with the Performance Reporting Team and/or others as needed to generate routine reports on provider plan-level and external appeals metrics for inclusion in regular performance reports to Vaya leadership, Vaya Board of Directors, and NCDHHS.
•  Monitor, track, process, and manage provider appeal requests; this includes updating documentation in the designated central electronic platform.
•  Coordinate and schedule, or oversee the coordination and scheduling of, panel hearings with internal staff, panelists, and provider representatives.
•  Assist in providing oversight of appeals processes handled by delegated subcontractors.
•  Issue electronic and/or physical notifications, and answer questions regarding the panel hearing process.
•  Manage all reconsideration documentation, record panel hearing minutes, draft decision notices for review by the attorney designated, and issue timely decision notices to all parties.
•  Maintain up to date procedures and processes for the Provider Appeals Committee and panel hearings.
•  Conduct annual and ad hoc training of panelists and presenters in consultation with the provider appeals facilitator and SAGC. Other Duties:

Note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

KNOWLEDGE, SKILL & ABILITIES
•  Ability to maintain the confidentiality of sensitive information in accordance with applicable laws, policies, and rules.
•  Ability to complete tasks in a timely and accurate manner click apply for full job details