Medicare Principal Attorney

Blue Cross and Blue Shield of MN is hiring a Medicare Principal Attorney. In this role you will provide prospective and responsive legal advice to anticipate and guard against legal risks involving the company. You will understand how the company is regulated and advise the business accordingly. Engages at a strategic level to help the company maximize the affordability of care within the appropriate legal confines. Keeps apprised of new and existing case law, statutes, regulations, and regulatory guidance to provide relevant advice to impacted areas of the company.

The Medicare Principal Attorney must be able to support and advise on the most complex and important issues facing the company, work with minimal oversight, communicate updates and escalate issues efficiently at the highest levels of leadership, apply sound and experienced judgment, appropriately prioritize tasks to focus on the key risks to the business, collaborate on or lead work involving multiple stakeholders including establishing clear expectations and holding others accountable, communicate legal advice both tactfully and persuasively, bring significant expertise to bear on issues, and identify effective and creative solutions to solve legal problems.

The ideal candidate is a highly skilled and experienced Medicare Principal Attorney to serve as a subject matter expert on Medicare-related legal and regulatory matters, advising the business on applicable federal and state laws. They will have in-depth knowledge of Medicare Advantage, Medicare Cost, and Part D programs. There is a strong preference for this role to be hybrid out of Eagan, MN.

A Day in the Life:

• Provide legal counsel and strategic guidance on Medicare Advantage, Medicare Cost, and Medicare Part D, including healthcare fraud and abuse laws (e.g., False Claims Act, anti-kickback statute), Bid Submission, Benefit Design, Risk Adjustment, Star Ratings, Marketing, Inflation Reduction Act, and Channel Management.

• Interpret CMS regulations, sub-regulatory guidance, and legislative developments affecting Medicare programs.

• Support regulatory compliance, including implementation of CMS Final Rules, Medicare-related audits, and responding to regulatory inquiries.

• Support contract drafting and negotiations with downstream entities, including providers, PBMs, and vendors, related to Medicare operations.

• Assist in the development of internal policies, procedures, and training programs to ensure legal and regulatory compliance.

• Advise leadership on risks and opportunities related to Medicare policy shifts.

• Collaborate with internal departments (e.g., Compliance, Government Markets Product, Marketing, Provider Relations, Risk Adjustment, Quality and Stars, Actuary, Clinical) on all things Medicare as a key stakeholder.

• Monitor Medicare-related litigation matters to identify risks and opportunities.

• Advise Appeals and Grievances and occasionally represent the company in Administrative Law Judge hearings regarding denial of benefits.

• Assist the Medicaid attorney with legal support for the Dual Special Needs product.

• Perform other duties as assigned.

Required Skills and Experiences:

• Degree in law and admission to the state bar.

• 10+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.

Preferred Skills and Experiences:

• 7+ years of experience in healthcare law, with a focus on Medicare programs.

• 7+ years of experience providing legal advisement on Medicare-related matters, including compliance with federal and state regulations, policy interpretation, and resolution of Medicare disputes.

• Proven ability to provide strategic legal counsel on Medicare-related matters, including Bid Submission, Benefit Design, Risk Adjustment, Star Ratings, Marketing, Inflation Reduction Act, and Channel Management.

• Experience supporting regulatory compliance, including implementation of CMS Final Rules, Medicare-related audits, and responding to regulatory inquiries.

• Skilled in drafting and negotiating contracts with downstream entities, including providers, PBMs, and vendors.

• Ability to assist in the development of internal policies, procedures, and training programs to ensure legal and regulatory compliance.

• Experience advising leadership on risks and opportunities related to Medicare policy shifts.

• Strong collaboration skills with internal departments (e.g., Compliance, Government Markets Product, Marketing, Provider Relations, Risk Adjustment, Quality and Stars, Actuary, Clinical).

• Ability to monitor Medicare-related litigation matters to identify risks and opportunities.

• Experience advising Appeals and Grievances and occasionally representing the company in Administrative Law Judge hearings regarding denial of benefits.

• Ability to assist the Medicaid attorney with legal support for the Dual Special Needs product.

We are the first in-house law department of any health care company in the United States to sign the well-being pledge for legal employers through the American Bar Association. We regularly and actively support attorneys and legal staff to take care of themselves and seek to improve their health and well-being. Some examples of this support include culture building activities and regular education and communication on well-being, mental health, and substance use disorders.