Commercial Disputes Attorney (Healthcare)

 Direct Counsel is representing an Am Law 100 firm in its search for a talented and dedicated midlevel associate to join the Commercial Disputes practice in its dynamic Orange County office.

The ideal candidate will have 3 to 5 years of health care litigation experience, preferably in payor-provider litigation. The successful candidate will demonstrate exceptional legal analysis, strategic thinking, and advocacy skills.

Responsibilities:

• Handle health care claims, including contents, processing, and appeals terminology (CPTs, HCPCS, DRG).

• Analyze communications between providers and insurers, including denial and approval letters.

• Interpret and analyze key contract provisions and provider manuals between health care systems and insurers.

• Review and interpret Summary Plan Descriptions, including reimbursement language, anti-assignment provisions, and medical necessity definitions.

• Examine administrative records for claims, including identifying categories of denials and underpayments (such as medical necessity, DRG downgrade, ED downgrades), as well as appeals information and account notes.

• Review claims details in Microsoft Excel, utilizing sorting, pivot tables, and VLOOKUP functions.

• Familiarity with extrapolation methodologies is a plus but not required.

Qualifications:

• Juris Doctor (J.D.) degree from an accredited law school.

• Admission to the California State Bar and in good standing.

• Excellent written and verbal communication skills.

• Ability to work independently and as part of a team in a fast-paced environment.

• Commitment to delivering high-quality legal services and achieving favorable outcomes for clients.

Candidates will work closely with experienced lawyers who provide active mentoring and opportunities to assume increasing levels of responsibility and client contact. Candidates must be self-starters with the ability to work independently and collaboratively. Strong academic credentials, excellent communication skills, and a commitment to providing the highest quality client service are required.

Compensation: Base salary: $250,000 - $360,000 per year

The compensation for this position will be determined during the interview process and will vary based on multiple factors, including but not limited to prior experience, relevant expertise, current business needs, and market conditions.