Senior Counsel

Upperline Health, Inc.; Nashville (TN); On-site; USD 150,000 - 230,000; Full time

Benefits offered by this job

Comprehensive medical, dental, vision,

Job summary

Upperline Health, Inc. is seeking a Senior Counsel, Healthcare Compliance to guide fraud and abuse compliance and regulatory matters for our national value-based care operations.

You will partner with the General Counsel to protect program integrity as we scale across multiple specialties. You will advise on CMS risk-based models (ACOs, MSSP, ACO REACH), Stark Law, AKS, and HIPAA, and help craft compliant payment models while supporting audits, investigations, and affiliate agreements.

Qualifications

• J.D. from an accredited law school and active license to practice
• 5+ years of healthcare regulatory/compliance experience
• Strategic counsel on value-based care arrangements and CMS risk-based models
• In-depth knowledge of Stark Law, Anti-Kickback Statute, False Claims Act, HIPAA
• Experience with multi-specialty coding and billing compliance
• Experience responding to CMS or OIG audits

Responsibilities

• Work with the General Counsel to provide strategic guidance to executives
• Advise on compliance requirements for CMS risk-based models (ACOs, MSSP, MA, etc.)
• Advise on Stark Law, AKS, False Claims Act and related regulations
• Partner with affiliate teams to craft payment models and ensure legal compliance
• Monitor CMS regulations affecting value-based reimbursement models
• Draft and update compliance policies across Upperline's service lines
• Support responses to government inquiries, audits, and investigations
• Review/approve physician compensation and value-based contracts for compliance
• Advise on managed care and payer contract terms
• Support privacy/security teams to protect PHI
• Oversee compliance training for leadership and frontline staff
• Serve as a resource for ad hoc compliance questions across markets

Skills

Regulatory compliance

Healthcare compliance

CMS risk-based models

Stark Law knowledge

HIPAA knowledge

Legal counsel

Education

J.D. from an accredited law school

Job description

ABOUT US

A Specialty Path to Good Health

Upperline Health is the nation's largest provider group dedicated to lower extremity, wound and vascular care. Founded in 2017 with the ambitious goal of transforming specialty care, Upperline Health is a pioneer in bringing value-based care models into specialty care. Upperline delivers a more efficient path for patients to receive consistent and effective treatment for chronic illnesses.

Triage is temporary.

Treatment is transformative.

Upperline Health providers coordinate patients' care among a team of specialists -- physicians, advanced practice providers, care navigators, pharmacists, dieticians, and social workers for integrated treatment that addresses patients' immediate and long-term health needs.

We put patients at the center of value-based care.

About the Senior Counsel, Healthcare Compliance

The Senior Counsel, Healthcare Compliance serves as a senior legal advisor across Upperline Health's value-based care operations, guiding fraud and abuse compliance and regulatory matters tied to Upperline's multi-specialty and risk-based care arrangements. This role partners closely with the General Counsel and Compliance function to protect value-based care program integrity as Upperline scales its national clinical footprint.

What You'll Do

• Work alongside the General Counsel to provide strategic guidance to company executives and guide internal policy to support the organization's value-based mission
• Advise on compliance requirements for CMS risk-based models in which Upperline participates, including ACO REACH, the LEAD Model, MSSP, MA and other shared savings arrangements
• Advise on the Stark Law, the Anti-Kickback Statute, the False Claims Act, state fraud and abuse laws, HIPAA and similar statutory and regulatory frameworks relevant to the organization
• Partner with the Partnership/Affiliate team to craft innovative payment models and ensure affiliate adherence to applicable law
• Monitor and interpret CMS regulations affecting value-based reimbursement models (ACOs, shared savings, risk-based contracts)
• Draft and update compliance policies and develop strategies regarding coding, billing, and documentation focus areas across Upperline's specialty service lines (podiatry, endocrinology, cardiology, vascular, chronic care management) and assist in implementing new clinical initiatives
• Support responses to government inquiries, audits, and civil investigative demands
• Review and approve physician/APP compensation arrangements, medical director agreements, and value-based contracts for regulatory compliance
• Advise on managed care and payer contracts, including risk-sharing and value-based payment terms
• Support privacy and security officers to ensure protection of Protected Health Information
• Oversee compliance training delivery to clinical and operational leadership on regulatory risk areas
• Serve as a resource for ad hoc frontline compliance questions across markets

Qualifications of the Senior Counsel, Healthcare Compliance

• J.D. from an accredited law school; active license to practice law in good standing
• 5+ years of healthcare regulatory/compliance legal experience, in-house or at a healthcare-focused law firm
• Experience providing strategic counsel on value-based care arrangements and advising on CMS risk-based/value-based payment models (ACOs, MSSP, ACO REACH, similar VBC programs)
• Deep knowledge of the Stark Law, Anti-Kickback Statute, False Claims Act, and HIPAA
• Experience with multi-specialty coding and billing compliance
• Prior experience responding to CMS or OIG audits and inquiries

Desired Qualities

• Ability to translate complex regulatory requirements into practical operational guidance
• Strong judgment balancing compliance risk against business growth objectives within a dynamic executive environment
• Excellent written and verbal communication with both legal and non-legal stakeholders
• High integrity and discretion handling sensitive topics and investigations

Benefits

• Comprehensive benefit options include medical, dental and vision, 401K and PTO.

Compensation

Compensation is commensurate to compensation for similar positions in the region and based on prior training and experience

Job Type: Full-time