Corporate Counsel - Payor Relations & Procurement

Job Overview:

The Corporate Counsel – Payor Relations and Procurement ("CC") provides high-level legal consultation and advice to TriHealth, its subsidiaries and affiliates. The CC supports the General Counsel, Deputy General Counsel and Legal Department to manage health care payor relations and system-wide procurement ensuring that sound legal guidance, strategic advice, consultation, analysis and interpretation is provided in a timely and efficient manner. The CC is expected to be an independent decision-maker with current knowledge of relevant federal and state laws, rules and regulations and accreditation requirements, as they pertain to TriHealth. The CC will be responsible for providing legal advice and guidance to internal stakeholders, including managed care, finance, revenue cycle and other departments on matters related to payor relations, contracts and compliance. This position will advise on legal issues arising from payor contract negotiations, disputes, denials, and other contractual issues. The CC will also support and be the main Legal contact to support TriHealth's supply chain and procurement efforts by reviewing and negotiating a wide variety of commercial contracts, including products, services, equipment, software and technology. The CC will work directly with executives and senior vice-presidents on such matters. The position requires specialized knowledge, high level attention to detail, and the ability to evaluate complex contractual arrangements and provide legal advice to support business goals while minimizing organizational risks.

Job Requirements:

Doctoral Degree Active Juris Doctorate Degree from ABA accredited law school and admitted to practice law in the State of Ohio. (Required)
10+ years of experience serving as in-house counsel in the healthcare industry or law firm experience supporting in-house hospital/health care clients. (Required)

Job Responsibilities:

Develop a keen understanding of the business and operational goals of TriHealth and maintain positive relationships with clients at all levels of the organization. 
Assist TriHealth departments in resolving payor disputes and denials related to commercial and governmental payors, direct-to-employer models and value-based arrangements. Ensure the TriHealth’s payor relations activities comply with all applicable laws, rules, and regulations. 
Advise on pay-for-performance, shared saving, narrow networks and other payor reimbursement models 
Review, draft and negotiate complex procurement contracts and provide sound advice regarding data privacy, cyber-security, HIPAA and related matters including data sharing and collection. 
Ensure contracts are legally sound, protect the company's interests, and comply with applicable laws and regulations. 
Take the lead on identifying the need for system-wide legal resources in the focus areas of payor relations and procurement and best practices and developing legal resources such as policies, templates and bulletins. 
Oversee and manage outside legal counsel and legal spend. Provide professional responsibilities in a manner consistent with the philosophy, mission, and values of TriHealth.

Working Conditions:

Bending - Rarely 
Climbing - Rarely 
Concentrating - Consistently 
Continuous Learning - Consistently 
Hearing: Conversation - Consistently 
Hearing: Other Sounds - Frequently 
Interpersonal Communication - Consistently 
Kneeling - Rarely 
Lifting Lifting 50+ Lbs. - Rarely 
Lifting Pulling - Rarely 
Pushing - Rarely 
Reaching - Rarely 
Reading - Consistently 
Sitting - Frequently 
Standing - Occasionally 
Stooping - Rarely 
Talking - Consistently 
Thinking/Reasoning - Consistently 
Use of Hands - Consistently 
Color Vision - Frequently 
Visual Acuity: Far - Frequently 
Visual Acuity: Near - Frequently 
Walking - Frequently

TriHealth SERVE Standards and ALWAYS Behaviors

At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following:

Serve: ALWAYS... 
• Welcome everyone by making eye contact, greeting with a smile, and saying "hello" 
• Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist 
• Refrain from using cell phones for personal reasons in public spaces or patient care areas

Excel: ALWAYS... 
• Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met 
• Offer patients and guests priority when waiting (lines, elevators) 
• Work on improving quality, safety, and service

Respect: ALWAYS... 
• Respect cultural and spiritual differences and honor individual preferences. 
• Respect everyone's opinion and contribution, regardless of title/role. 
• Speak positively about my team members and other departments in front of patients and guests.

Value: ALWAYS... 
• Value the time of others by striving to be on time, prepared and actively participating. 
• Pick up trash, ensuring the physical environment is clean and safe. 
• Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.

Engage: ALWAYS... 
• Acknowledge wins and frequently thank team members and others for contributions. 
• Show courtesy and compassion with customers, team members and the community