Senior Counsel, Value-Based Healthcare Compliance

Upperline Health Inc; Nashville (TN); Hybrid; USD 170,000 - 210,000; Full time

Benefits offered by this job

Medical, dental, vision benefits

401K plan

Paid time off

Job summary

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

You will partner with the General Counsel to protect program integrity as the national footprint grows. You will advise on CMS risk-based models (ACOs, MSSP, REACH, LEAD), Stark/AKS/FCA/HIPAA issues, and develop coding, billing, and documentation strategies.

Qualifications

• J.D. from an accredited law school with active license to practice law.
• 5+ years of healthcare regulatory/compliance experience, in-house or at a healthcare-focused firm.
• Strategic counsel on value-based care arrangements 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; CMS/OIG audits.

Responsibilities

• Provide strategic guidance to executives and internal policy to support value-based care.
• Advise on CMS risk-based models and compliance requirements (ACOs, MSSP, REACH, LEAD).
• Interpret and apply Stark Law, AKS, FCA, HIPAA in arrangements and contracts.
• Draft, update compliance policies; oversight of coding, billing, and documentation.
• Support responses to government inquiries, audits, and civil investigations.
• Review compensation and agreements for regulatory compliance; advise on payer contracts.
• Collaborate with privacy and security teams to protect PHI; deliver compliance training.

Skills

Regulatory compliance

Healthcare law

CMS risk-based models

Policy guidance

In-house counsel

Education

J.D. from an accredited law school

Tools

Westlaw

LexisNexis

Job description

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

You will partner with the General Counsel to protect program integrity as the national footprint grows. You will advise on CMS risk-based models (ACOs, MSSP, REACH, LEAD), Stark/AKS/FCA/HIPAA issues, and develop coding, billing, and documentation strategies.