Aetna Administrative Hearing Paraleg in Phoenix, Arizona

Req ID: 52920BR

POSITION SUMMARY

Office Based in Phoenix AZ

Aetna is the third party administrator for Mercy Care, an integrated Medicaid plan in Arizona with a Medicare Advantage D-SNP line of business. The paralegal will provide support to one or more hearing attorneys for Medicaid and Medicare fair hearing matters, including hearing preparation and research; and will also work with others on the Mercy Care legal team to achieve team and business goals.

Fundamental Components:

  • Performs paralegal tasks specific to Medicaid administrative state fair hearings related to Mercy Care grievance and appeals.

  • Conducts legal and investigative research and analysis for member appeals and provider claim disputes, including research of relevant state and federal regulations, rules and policies.

  • Researches and applies knowledge of legal, regulatory and procedural developments that relate to specialty, as well as clients business goals, plans and priorities to all member appeals and provider claim disputes.

  • Participates in due diligence; conducts fact finding, document gathering and document creation (such as, exhibits, motions and letters).

  • Manage and transmit state fair hearing requests to Medicaid regulator in a timely and accurate manner.

  • Ensure all hearing information and documentation is entered into appropriate databases and calendars, as required, accurately and in a timely manner.

  • Manage electronic case files and coordinate file reviews by the relevant department or subject matter expert.

  • Coordinate and schedule staffings and meetings for hearing review as required by the assigned hearing attorney.

  • Other miscellaneous projects as needed by the Mercy Care legal team.

    BACKGROUND/EXPERIENCE desired:

  • 5 or more years of experience as a paralegal, with at least 3 years of experience in a litigation support function.

  • At least a Paralegal Certificate or Associate's degree in paralegal studies, bachelors degree preferred in addition to paralegal certification.

  • Solid foundation in Microsoft Office programs, such as, AdobePro, Word, Excel, Outlook, PowerPoint, etc.

  • Solid foundation in managing electronic case files; all case files and documentation is maintained in electronic format.

  • Experience or familiarity with Medicare and Medicaid regulations and programs.

  • Experience in healthcare complaints, grievances & appeals.

    EDUCATION

    The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.

    LICENSES AND CERTIFICATIONS

    Legal/Paralegal Certificate is desired

    Legal/National Association of Legal Assistants (NALA) is desired

    FUNCTIONAL EXPERIENCES

    Functional - Legal/Compliance - law searches/4-6 Years

    Functional - Legal/Litigation/4-6 Years

    Functional - Medical Management/Medical Management - Complaints, Grievance & Appeals/1-3 Years

    Functional - Legal/Compliance - state/federal legislation implementation/1-3 Years

    TECHNOLOGY EXPERIENCES

    Technical - Desktop Tools/Adobe Acrobat Suite v5/4-6 Years/Power User

    Technical - Desktop Tools/Microsoft Outlook/4-6 Years/Power User

    Technical - Desktop Tools/Microsoft Word/4-6 Years/Power User

    Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User

    REQUIRED SKILLS

    Leadership/Collaborating for Results/ADVANCED

    Leadership/Driving a Culture of Compliance/ADVANCED

    Service/Providing Solutions to Constituent Needs/ADVANCED

    ADDITIONAL JOB INFORMATION

    The Mercy Care legal team is a team focused on quality work and collaboration to achieve the right outcomes for the right reasons. Our team works closely with one another to support each other creating a culture of teamwork, accountability and success.

    Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

    We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

    Together we will empower people to live healthier lives.

    Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

    We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

    Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

    Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Legal