Aetna is the third party administrator for Mercy Care, an integrated Medicaid plan in Arizona with an affiliated Medicare Advantage D-SNP plan. The paralegal will provide support to one or more hearing attorneys for Medicaid and Medicare state fair hearing matters, including submission of hearing requests to regulators, hearing preparation and research, hearing tracking and reporting to regulators; and will also work with others on the Mercy Care legal team to achieve team and business goals.
Under the direction and supervision of an attorney performs paralegal work related to Medicaid and Medicare state fair hearings, and other projects as needed.
- Prepares hearing files, drafts basic legal documents, conducts basic legal and investigative research and analysis.
- Manage and transmit state fair hearing requests to regulators 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.
- Participates in due diligence; conducts fact finding and document gathering e.g. records for medical or claim review.
- Participates in projects and cases. Maintains and tracks certain hearing files.
- Researches and applies knowledge of legal, regulatory, and procedural developments that relate to Medicaid and Medicare, as well as, the clients' business goals, plans and priorities.
- Develops and maintains effective working relationships with clients to facilitate effective teamwork, communication and client focus.
- May investigate and assist in the resolution of member grievances and appeals, and provider claim disputes at the state fair hearing level.
- Undertakes continuing legal and/or relevant education per calendar year, including attendance at internal company training programs, in-house or outside seminars.
- 5 or more years of experience as a paralegal, with at least 3 years of experience in a litigation support function.
- Experience managing high case file volume and or large document production.
- Experience researching codes, statutes, and regulatory policies.
- 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.
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 in a fast paced practice.
Associate's degree or equivalent experience
Percent of Travel Required
0 - 10%
Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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