**Job Description:** Under the direction of the Essentia Health Chief Legal Officer, this position provides enterprise-wide legal leadership focused on claims denials oversight, prior authorization appeals, and administrative law proceedings. The role serves as the primary legal strategist and representative for complex government and commercial payor disputes, with particular emphasis on Medicare and high-risk denial categories.This position partners closely with Revenue Cycle, Payor Relations, Contracting, Clinical Leadership, and Compliance teams to prevent downstream losses, standardize appeals processes, strengthen payor accountability, and improve patient access to medically necessary care.The role may also provide legal support across other substantive areas within Legal and Regulatory Services (LRS) on an as-needed basis, consistent with organizational priorities. **Education Qualifications:** **Qualifications** **Education** + Juris Doctor (JD) from an accredited law school. **Licensure** + Current Minnesota, Wisconsin, or North Dakota Attorney license (or eligibility for licensure). **Experience** + Minimum of three (3) years of legal experience in healthcare law, administrative law, reimbursement, or complex regulatory litigation. + Demonstrated experience in: + Medicare appeals processes and administrative hearings + Payor disputes and reimbursement litigation + Healthcare regulatory compliance + Contract interpretation and negotiation + Experience working cross-functionally with clinical, operational, and financial leaders preferred. **Primary Responsibilities** **Denials & Appeals Legal Leadership** + Lead legal strategy for enterprise-wide denials and appeals across government and commercial payors. + Represent Essentia Health in: + Administrative Law Judge (ALJ) hearings + Medicare Appeals Council proceedings + Other administrative forums as appropriate + Provide legal oversight for: + Medicare NCD/LCD determinations + Inpatient medical necessity denials (concurrent and retrospective) + Clinical validation and audit-related denials + Prior authorization denials + Commercial payor disputes involving contract interpretation + Ensure timely filing and escalation of appeals to minimize avoidable write-offs. **Strategic & Preventive Legal Partnership** + Collaborate with Contracting and Payor Relations teams to proactively address denial trends and contract language risks. + Partner with Revenue Cycle and Clinical teams to reduce denial risk upstream. + Identify systemic denial patterns and recommend enterprise mitigation strategies. + Support development and implementation of standardized appeals processes and best practices. **Process Improvement & Innovation** + Establish enterprise-wide training programs for appeals formulation and documentation. + Develop scalable workflows and governance structures for denial oversight. + Support development and implementation of AI and automation tools to improve appeals efficiency and outcomes. + Build metrics and reporting structures to evaluate legal and financial impact. **Enterprise Risk & Patient Advocacy** + Strengthen payor accountability and contract performance. + Reduce clinician and operational burden related to denial management. + Ensure legally sound advocacy to support timely patient access to medically necessary care. + Provide risk assessment and executive guidance related to denial exposure and litigation trends. **Additional Responsibilities** + Provide counsel to leadership on regulatory and reimbursement-related matters. + Support other LRS substantive areas as needed, consistent with departmental practice and organizational needs. **Knowledge, Skills & Competencies** + Strong administrative law and healthcare reimbursement expertise. + Litigation and hearing advocacy skills. + Strategic thinker with ability to build scalable systems. + Financial acumen and understanding of revenue cycle operations. + Ability to influence without direct authority. + Strong executive communication and presentation skills. + High degree of initiative and ability to operate independently. **Expected Impact of Role** + Improved appeal success rates and reduced revenue leakage. + Strengthened enterprise-wide denial strategy. + Reduced clinician and operational administrative burden. + Faster resolution of denials impacting patient care. + Improved payor accountability and contract compliance. + Enhanced alignment across legal, clinical, and financial functions. **Licensure/Certification Qualifications:** **Required Licensure** + Current Minnesota, Wisconsin or North Dakota Attorney’s license or eligibility for licensure. Employee Benefits at Essentia Health: At Essentia Health, we’re committed to supporting your well-being, growth, and work-life balance. Our comprehensive benefits include medical, dental, vision, life, and disability insurance, along with supplemental options to fit your needs. We offer a 401(k) plan with employer contributions to help you plan for the future, and we invest in your professional development through training, tuition reimbursement, and educational programs. To help you thrive both at work and at home, we provide flexible scheduling, generous time off, and wellness resources focused on your physical, mental, and emotional health. Please note that benefit eligibility may vary. For full details, refer to your benefit summary or contact our HR Service Center at (218) 576-0000. **Job Location:** Building D - Miller Dwan Medical Center - EH Duluth **Shift Rotation:** Day Rotation (United States of America) **Shift Start/End:** / **Hours Per Pay Period:** **Compensation Range:** $77.87 - $116.81 / hour **Union:** **FTE:** 1 **Weekends:** **Call Obligations:** **Sign On Bonus:** It is our policy to afford EEO to all individuals, regardless of race, religion, color, sex, pregnancy, gender identity, national origin, age, disability, family medical history, genetic information, sexual orientation, marital status, military service or veteran status, culture, socio-economic status, status with regard to public assistance, and other factors not related to qualifications, including employees or applicants who inquire about, discuss, or disclose their compensation or the compensation of other employees or applicants, or membership or activity in a local human rights commission, or any other category as defined by law.