Senior Counsel, Payers & Revenue

We are so glad you are interested in joining Sutter Health!

Organization:

SHSO-Sutter Health System Office-Valley

Position Overview:

The Senior Counsel is responsible for providing expert-level legal advice and management of complex legal and operational issues within the Managed Care, Revenue Cycle, and Finance domains. This role plays a critical part in advancing the organization’s business objectives by delivering strategic legal guidance, mitigating legal risk, and supporting key negotiations and regulatory initiatives.

Key Responsibilities

Managed Care Contracting Support

Serve as primary legal partner to the Managed Care Contracting department.

Advise on negotiation strategy and draft, review, and negotiate complex payer agreements, amendments, and related documents.

Support dispute resolution efforts, including payer challenges, arbitration, and contract interpretation matters.

Provide legal guidance on contract compliance, reimbursement methodologies, value-based arrangements, and network participation requirements.

Revenue Cycle & Finance Support

Provide daily legal counsel on Revenue Cycle operations, including billing, collections, reimbursement, denials management, and regulatory compliance.

Advise the Finance department on regulatory requirements, state and federal payment rules, and compliance issues affecting reimbursement.

Interpret and apply federal and state health care laws, including Medicare/Medicaid regulations, managed care rules, prompt-pay statutes, and payment integrity standards.

Job Description:

This is a hybrid role. Candidate must live in the Northern California Sutter Health footprint and come on site as needed for meetings, work etc.

EDUCATION:
Doctorate: Juris Doctorate - Law

CERTIFICATION & LICENSURE:
ATT-Attorney
RIHC-Registered In House Counsel within 30 Days of hire OR California Licensed Attorney

TYPICAL EXPERIENCE:
5 years of recent relevant experience.

SKILLS AND KNOWLEDGE:
Significant knowledge and experience of working with statutes and regulations governing California law in Area of Law Expertise.

Knowledge of laws related to not-for-profit healthcare operations requirements is preferred. This knowledge should include corporate governance, tax-exemption, Stark, Anti-kickback, False Claims Act, licensure, certification and accreditation.

Expert ability to give practical and proactive legal advice in Area of Law Expertise.

Ability to advise senior management regarding the impact of business strategies and/or emerging trends in Area of Law Expertise.

Interpersonal, negotiation and analytical skills to effectively resolve issues and influence others outside of reporting relationships or lines of authority.

Must exhibit a credible leadership presence, with the ability to respond to questions with logic, clarity, calmness and authority, leading to desired support of/ actions by others.

Knowledge of the elements of healthcare ethics and compliance programs.

Knowledge of current privacy regulations and other pertinent and applicable state and federal regulations related to Protected Health Information (PHI) as connected to Area of Law Expertise.

Knowledge of other disciplines outside of own Area of Law Expertise, including business planning, clinical disciplines, human resources, finance, licensing, accreditation, clinical and financial auditing, and information technology.

Verbal, written and presentation skills, including the ability to translate complex legal and regulatory requirements/issues into terms readily understood by all levels of employees and corporate executives.

Client management and project management skills and be able to work successfully both independently and within a team.

Self-directed and works with minimal supervision, both independently and in teams.

Adapts quickly to changing conditions, assimilating new processes into job functions and taking ownership.

Exceptional organizational skills and the ability to balance numerous priorities at a given time with minimal supervision.

Must be able to reason logically, analyze situations accurately and recommend courses of action.

Ability to organize, plan and coordinate work flow, and to work effectively with colleagues to achieve success with objectives.

Ability to reprioritize effectively among diverse clients, high-risk events or projects and have high attention to detail and the ability to analyze complex fact scenarios quickly.

Ability to diplomatically investigate sensitive facts and detailed procedures.

Ability to maintain confidentiality of sensitive material, including protected health information, executives’ personally identifiable information, payroll information, legal documents and other corporate data and exercise good judgment as it relates to handling of sensitive material.
 

Job Shift:

Days

Schedule:

Full Time

Days of the Week:

Monday - Friday

Weekend Requirements:

Occasionally

Benefits:

Yes

Unions:

No

Position Status:

Exempt

Weekly Hours:

40

Employee Status:

Regular

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $103.42 to $165.48 / hour

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package. ​