Senior Counsel, Value-Based Healthcare Compliance

Upperline Health, Inc.; Nashville (TN); Presencial; USD 150 000 - 230 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Comprehensive medical, dental, vision,

Resumo da oferta

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.

Qualificações

• 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

Responsabilidades

• 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

Conhecimentos

Regulatory compliance

Healthcare compliance

CMS risk-based models

Stark Law knowledge

HIPAA knowledge

Legal counsel

Formação académica

J.D. from an accredited law school

Descrição da oferta de emprego

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.