The Legal Review Specialist is responsible for reviewing appeal determinations and case files for legal and regulatory sufficiency. They also provide guidance on complex Medicare policy matters and support administrative hearings and government inquiries.
This position is contingent upon the successful award of the associated contract. Employment is not guaranteed until the contract is awarded, and the position is officially activated. Job responsibilities and requirements are subject to change.
Position: Legal Review Specialist Location: Remote Status: Part-time About J29 J29 is an employee centered healthcare management consulting company that specializes in processing, reviewing, and analyzing medical claims, records, disputes, and audits. Established in 2017, J29 prides itself on its employee centric culture and high employee retention rates that allow us to ensure that we are creating a working environment that prioritizes the employee experience. Our team brings corporate performance that stretches to various areas where we can provide our clinical, healthcare policy, and compliance expertise through our support to health and human service programs at the State, Federal, and Commercial levels.
Overview J29 is seeking a Legal Review Specialist to provide regulatory and legal analysis in support of federally funded healthcare programs and Medicare appeals operations. This role is responsible for reviewing appeal determinations, evaluating supporting documentation for legal and regulatory sufficiency, interpreting Medicare statutes and regulations, and providing guidance on complex policy and adjudicatory matters.
The Legal Review Specialist serves as a key resource in ensuring that appeal determinations and related review materials are accurate, defensible, and consistent with applicable federal laws, regulations, and agency guidance. The ideal candidate possesses extensive knowledge of Medicare regulations and appeals processes, strong analytical and writing skills, and experience supporting healthcare compliance, program integrity, or government healthcare initiatives.
Role & Responsibilities
Review appeal determinations, case files, and supporting materials for legal and regulatory sufficiency.
Analyze complex Medicare policy, statutory, and regulatory issues related to appeals and coverage determinations.
Advise internal stakeholders on the interpretation and application of Medicare statutes, federal regulations, agency guidance, and sub-regulatory materials.
Support responses to government inquiries and requests involving regulatory, legal, or policy-related matters.
Assist in the preparation of materials for administrative hearings, adjudicatory reviews, and higher-level appeal proceedings.
Conduct legal and regulatory research to support appeal determinations and program operations.
Evaluate case documentation and determination rationales to ensure consistency with applicable legal and regulatory requirements.
Identify regulatory risks, compliance concerns, and policy implications associated with appeal outcomes.
Draft and review legal memoranda, policy analyses, issue papers, and written recommendations.
Collaborate with clinical reviewers, appeals analysts, operational staff, and leadership to address complex regulatory and case-specific issues.
Support quality assurance, audit readiness, and compliance review activities.
Monitor changes in Medicare regulations, agency guidance, and adjudicatory requirements and communicate impacts to stakeholders.
Assist in the development and maintenance of policies, procedures, and operational guidance.
Experience / Expertise
Juris Doctor (JD) from an accredited law school preferred; equivalent legal, regulatory, or healthcare policy experience may be considered or Bachelor's degree required.
Seven (7) or more years of experience supporting Medicare, healthcare regulatory compliance, appeals, program integrity, policy analysis, or federal healthcare programs.
Experience with Medicare statutes, CFR interpretation, or CMS adjudicatory processes
Preferred Qualifications
Experience supporting CMS, OGC, or federal healthcare programs preferred
Hourly Rate: $58-$63 hourly based on years of experience
J29, Inc. is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class. J29, Inc. is a proud Veteran friendly employer.
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