Senior Counsel
Upperline Health, Inc.
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Benefits offered by this job
Job summary
Upperline Health, Inc. is seeking a Senior Counsel, Healthcare Compliance to guide fraud and abuse compliance and regulatory matters tied to value-based care across its multi-specialty operations.
You will partner with the General Counsel to protect program integrity as Upperline scales nationally. Responsibilities include advising on CMS risk-based models (ACOs, MSSP, ACO REACH), Stark and HIPAA, and developing compliant payment and contracting strategies.
Qualifications
- J.D. from an accredited law school with active license to practice.
- 5+ years healthcare regulatory/compliance legal experience.
- Experience with CMS risk-based/value-based models (ACOs, MSSP, ACO REACH).
- Deep knowledge of Stark Law, Anti-Kickback Statute, False Claims Act, HIPAA.
- Experience with multi-specialty coding and billing compliance.
- Prior experience responding to CMS or OIG audits and inquiries.
Responsibilities
- Advise executives and guide internal policy to support value-based care.
- Provide strategic guidance on CMS risk-based models and shared savings.
- Advise on Stark Law, AKS, False Claims Act, and HIPAA frameworks.
- Partner with partnerships/affiliate teams to craft compliant payment models.
- Monitor CMS regulations affecting value-based reimbursement models.
- Draft/update compliance policies for coding, billing and documentation.
- Support responses to government inquiries, audits, and civil demands.
- Review physician/APP compensation and value-based contracts for compliance.
- Advise on managed care and payer contracts with risk-sharing terms.
- Support privacy officers to protect PHI and oversee training delivery.
Skills
Education
Job description
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.
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.
- 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
- 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
- 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
Comprehensive benefit options include medical, dental and vision, 401K and PTO.
Compensation is commensurate to compensation for similar positions in the region and based on prior training and experience
Job Type: Full-time
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.
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.
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.
- 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
- 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
- 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
Comprehensive benefit options include medical, dental and vision, 401K and PTO.
Compensation is commensurate to compensation for similar positions in the region and based on prior training and experience
Job Type: Full-time
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.
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