Dir ALJ Appeals

This position is incentive eligible.

Do you want to join an organization that invests in you as a Director ALJ Appeals? At HCA Healthcare, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.

Job Summary and Qualifications

As the Director of ALJ Appeals, you will provide strategic leadership and operational oversight of the Medicare Administrative Law Judge (ALJ) appeals function, ensuring the delivery of timely, accurate, and defensible appeals. This role serves as a subject matter expert and actively contributes to complex appeal filings and ALJ hearings, including case strategy and representation support. The Director oversees and evaluates government contractor activity, identifying risk, escalation opportunities, and alignment with appeal strategies. Additionally, this position partners across Regulatory Compliance Support to provide expert guidance, support enterprise initiatives, and drive regulatory and operational excellence.

Job Responsibilities:

• Lead and oversee the end-to-end Medicare Administrative Law Judge (ALJ) appeals function, ensuring timely, accurate, and compliant filings and adjudication readiness.
• Serve as a subject matter expert and active participant in ALJ hearings, including case filing and strategy, witness preparation, and representation support.
• Establish and continuously optimize ALJ appeals processes, controls, and standard operating procedures to drive consistency, quality, and regulatory compliance.
• Direct performance management of the ALJ appeals program, including development, tracking, and reporting of key performance indicators (KPIs), outcomes, and risk trends.
• Manage and develop internal staff and external contractors, ensuring appropriate staffing models, productivity, and accountability standards.
• Provide strategic support and guidance related to government contractor activity (e.g., MACs, RACs, UPICs), identifying risks and escalation pathways.
• Lead appeal strategy alignment for government audits and reviews (e.g., OIG, self-audits, state audits), including early case assessment, issue prioritization, and ALJ-level escalation planning.
• Partner cross-functionally with compliance, legal, revenue cycle, and operations to align appeal strategies with enterprise risk and financial objectives.
• Drive continuous improvement initiatives, leveraging data analytics and industry insights to enhance appeal success rates and operational efficiency.
• Lead and contribute to high-impact special projects, providing regulatory and litigation expertise to support organizational priorities.
• Foster a culture of integrity, accountability, and high performance, aligned with organizational mission, values, and Code of Conduct.
• Ensure adaptability to evolving regulatory requirements, audit trends, and organizational needs, executing additional responsibilities as required.

Job Requirements:

• Bachelor's degree Required
• Juris Doctorate (JD) Required
• 7+ years experience in Litigation Required
• Previous supervisory experience Preferred
• License to practice law in Tennessee is Required
• Strong writing communication skills is Required
• Knowledge of administrative law and procedure is Required
• Ability to adjust priorities and manage time wisely in a fast paced environment is Required

Benefits

HCA Healthcare, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

HCA Healthcare (Corporate), based in Nashville, Tennessee, supports a variety of corporate roles from business operations to administrative positions. Like our colleagues in any HCA Healthcare hospital, our corporate campus employees enjoy unparalleled resources and opportunities to reach their potential as healthcare leaders and innovators. From market rate compensation to continuing education and career advancement opportunities, every person has a solid foundation for success. Nashville is also home to our Executive Development Program, where exceptional employees are groomed to take on CNO- and COO-level roles in our hospitals. This selective program focuses on ethics, leadership and the financial and clinical knowledge required of professionals at this level of the industry.

HCA Healthcare has been recognized as one of the World's Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"Good people beget good people."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder

We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Dir ALJ Appeals opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.