Senior Counsel, Healthcare Compliance & Value-Based Care

Silversmith Capital Partners; Nashville (TN); On-site; USD 180,000 - 270,000; Full time

Benefits offered by this job

Medical, dental and vision

401K

PTO

Job summary

Upperline Health seeks a Senior Counsel, Healthcare Compliance to guide fraud, abuse, and regulatory matters as the company expands its national value-based care footprint. You will partner with the General Counsel to shape internal policy and ensure regulatory integrity across multi-specialty programs.

Ideal candidates have 5+ years in healthcare regulatory/compliance, deep Stark/AKS/FCA/HIPAA knowledge, and prior CMS or OIG audit experience.

Qualifications

• 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 and CMS risk-based models
• Deep knowledge of 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

Responsibilities

• Work alongside the General Counsel to guide executives and shape internal policy for value-based care
• Advise on CMS risk-based models and shared savings arrangements (ACOs, MSSP, ACO REACH)
• Advise on Stark Law, Anti-Kickback, False Claims Act, and HIPAA compliance
• Collaborate with Partnership/Affiliate teams to craft compliant payment models
• Monitor CMS regulations affecting value-based reimbursement models
• Draft and update compliance policies for coding, billing and documentation
• Support responses to government inquiries, audits, and investigations
• Review physician/APP compensation and value-based contracts for regulatory compliance
• Advise on managed care and payer contracts with risk-sharing terms
• Support privacy and security officers on PHI protection
• Oversee compliance training for leadership on regulatory risk areas
• Provide frontline compliance guidance across markets

Skills

Healthcare regulatory compliance

CMS risk-based models

Stark Law & False Claims Act

HIPAA knowledge

Regulatory audits

Education

J.D. from an accredited law school

Active license to practice law

Tools

Regulatory research

Job description

Upperline Health seeks a Senior Counsel, Healthcare Compliance to guide fraud, abuse, and regulatory matters as the company expands its national value-based care footprint. You will partner with the General Counsel to shape internal policy and ensure regulatory integrity across multi-specialty programs.

Ideal candidates have 5+ years in healthcare regulatory/compliance, deep Stark/AKS/FCA/HIPAA knowledge, and prior CMS or OIG audit experience.