Overview
A healthcare technology organization is building a new healthcare clearinghouse to modernize the exchange of insurance transactions such as claims, eligibility checks, prior authorizations, and remittances. This clearinghouse will support standardized EDI formats required by HIPAA and provide modern API interfaces alongside traditional real-time and batch EDI processes. The clearinghouse aims to replace legacy systems built on outdated technology with a programmable, customer-focused platform.
Responsibilities
- Develop and implement regulatory and legal strategies to strengthen relationships with payers, ensuring compliance with enforcement and regulatory requirements.
- Lead legal efforts in competitive and enforcement matters to defend and advance the organization's market position.
- Establish legal frameworks for innovative data products operating in complex regulatory environments, turning uncertainty into defensible product strategies.
- Use legal and regulatory expertise to identify growth opportunities, facilitate deals, and remove obstacles.
- Manage the full scope of legal functions alongside the Head of Legal, including commercial agreements, disputes, compliance, intellectual property, employment, corporate governance, and fundraising.
- Collaborate directly with the CEO and board on strategic decisions influenced by legal and regulatory considerations.
Requirements
- Minimum of 10 years of relevant legal experience, including significant in-house roles managing litigation and disputes, preferably at high-growth companies.
- Strong healthcare industry experience is highly preferred, with familiarity in regulatory and commercial complexities involving healthcare infrastructure, payers, providers, or health technology. Alternatively, deep experience in other heavily regulated, complex industries such as financial services, payments, or insurance is considered.
- Broad legal expertise capable of addressing diverse issues across multiple domains without needing to refer matters externally.
- Ability to work quickly and keep pace with a fast-moving organization.
- Commercially minded with a business-oriented approach to legal strategy.
- Juris Doctor (JD) degree and active membership in at least one U.S. state bar.
Preferred Qualifications
- Experience shaping legal strategies that directly influence market outcomes.
- Proven ability to build legal frameworks for novel products in regulated sectors.
- Experience partnering with executive leadership and boards on strategic legal matters.
Compensation & Benefits
Details about compensation and benefits are not provided in the original description.
Location
Location details are not specified in the original description.