Job description

Empower AI is AI for government. Empower AI gives federal agency leaders the tools to elevate the potential of their workforce with a direct path for meaningful transformation. Headquartered in Reston, Va., Empower AI leverages three decades of experience solving complex challenges in Health, Defense, and Civilian missions. Our proven Empower AI Platform® provides a practical, sustainable path for clients to achieve transformation that is true to who they are, what they do, how they work, with the resources they have. The result is a government workforce that is exponentially more creative and productive. For more information, visit www.Empower.ai . Empower AI is proud to be recognized as a 2024 Military Friendly Employer by Viqtory, the publisher of G.I. Jobs. This designation reflects the company’s commitment to hiring and supporting active-duty and veteran employees. Lead neutral legal and adjudicative support for CMS Office of Hearings activities, primarily Medicare Advantage Risk Adjustment Data Validation (RADV) appeals. Research complex issues, synthesize multidisciplinary findings, and draft clear, defensible recommendations and proposed decisions for the CMS Hearing Officer. This is a part time position. Key Responsibilities: • Review RADV appeal requests, briefs, motions, hearing records, and supporting documentation. • Research and apply statutes, regulations, CMS guidance, policies, procedures, and precedent. • Draft and review legal memoranda, orders, notices, recommendations, and proposed decisions. • Evaluate jurisdictional, procedural, and substantive issues and escalate material risks or deficiencies. • Integrate legal, medical, coding, and case-management findings into neutral, well-supported recommendations. • Provide final quality review, guide legal support staff, coordinate with CMS and project leadership, and maintain compliant case records. Requirements: • Bachelor’s degree in legal studies, paralegal studies, health policy, public administration, or a related field, or equivalent education and experience. • 10+ years of progressively responsible legal, regulatory, compliance, administrative appeals, or healthcare policy experience. • 5+ years drafting or substantively reviewing legal briefs, memoranda, recommendations, proposed decisions, orders, opinions, or comparable analytical work products. • Knowledge of Medicare or Medicaid law, healthcare appeals, managed care, or regulatory oversight. • Demonstrated strength in complex legal research, neutral analysis, decision writing, quality review, communication, organization, and deadline management. • Proficiency with Microsoft Office and legal, document, or case-management systems; ability to obtain required suitability and system access. Preferred Qualifications: • Juris Doctor degree from an accredited law school and active bar admission in a U.S. jurisdiction. • Experience with administrative hearings, appeals, adjudications, decision writing, or judicial clerkship work. • Experience supporting federal hearing officers or administrative law judges. • Direct experience with CMS appeals, Medicare Advantage, RADV, or healthcare regulatory adjudication. All hiring and promotion decisions at Empower AI are based on merit to bring the best talent available to contribute to our firm’s overall success. It is the policy of Empower AI not to discriminate against any applicant for employment, or employee because of age, color, sex, disability, national origin, race, religion, or veteran status. Empower AI is a VEVRAA Federal Contractor. If hired for this position, the base salary range would be within the range provided. The base salary range represents the anticipated low and high end of the salary range for this position. Actual salaries may vary based on various factors including but not limited to work location, skills, experience, gov con contractual requirements, and performance. The range listed is just one component of Empower AI's total compensation package for employees. USD $55.88/Hr. USD $86.49/Hr. We can recommend jobs specifically for you! Click here to get started.

Requirements

Must-haves

Review RADV appeal requests, briefs, motions, hearing records, and supporting documentation.
Research and apply statutes, regulations, CMS guidance, policies, procedures, and precedent.
Draft and review legal memoranda, orders, notices, recommendations, and proposed decisions.
Evaluate jurisdictional, procedural, and substantive issues and escalate material risks or deficiencies.
Integrate legal, medical, coding, and case-management findings into neutral, well-supported recommendations.
Provide final quality review, guide legal support staff, coordinate with CMS and project leadership, and maintain compliant case records.
Bachelor’s degree in legal studies, paralegal studies, health policy, public administration, or a related field, or equivalent education and experience.
10+ years of progressively responsible legal, regulatory, compliance, administrative appeals, or healthcare policy experience.
5+ years drafting or substantively reviewing legal briefs, memoranda, recommendations, proposed decisions, orders, opinions, or comparable analytical work products.
Knowledge of Medicare or Medicaid law, healthcare appeals, managed care, or regulatory oversight.
Demonstrated strength in complex legal research, neutral analysis, decision writing, quality review, communication, organization, and deadline management.
Proficiency with Microsoft Office and legal, document, or case-management systems; ability to obtain required suitability and system access.

Nice-to-haves

Juris Doctor degree from an accredited law school and active bar admission in a U.S. jurisdiction.
Experience with administrative hearings, appeals, adjudications, decision writing, or judicial clerkship work.
Experience supporting federal hearing officers or administrative law judges.
Direct experience with CMS appeals, Medicare Advantage, RADV, or healthcare regulatory adjudication.
USD $55.88/Hr.
USD $86.49/Hr.
We can recommend jobs specifically for you!
Click here to get started.

Application prep

Use the role’s language and application details while tailoring your materials.

Keywords to mirror

Platform: icims
Effort: medium