Senior Counsel (Immediate Hire)

ABOUT USA Specialty Path to Good HealthUpperline 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. Triage is temporary.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 ComplianceThe 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 DoWork alongside the General Counsel to provide strategic guidance to company executives and guide internal policy to support the organization's value-based missionAdvise on compliance requirements for CMS risk-based models in which Upperline participates, including ACO REACH, the LEAD Model, MSSP, MA and other shared savings arrangementsAdvise 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 organizationPartner with the Partnership/Affiliate team to craft innovative payment models and ensure affiliate adherence to applicable lawMonitor 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 initiativesSupport responses to government inquiries, audits, and civil investigative demandsReview and approve physician/APP compensation arrangements, medical director agreements, and value-based contracts for regulatory complianceAdvise on managed care and payer contracts, including risk-sharing and value-based payment termsSupport privacy and security officers to ensure protection of Protected Health InformationOversee compliance training delivery to clinical and operational leadership on regulatory risk areasServe as a resource for ad hoc frontline compliance questions across marketsQualifications of the Senior Counsel, Healthcare ComplianceJ.D. from an accredited law school; active license to practice law in good standing5+ years of healthcare regulatory/compliance legal experience, in-house or at a healthcare-focused law firmExperience 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 HIPAAExperience with multi-specialty coding and billing compliancePrior experience responding to CMS or OIG audits and inquiriesDesired QualitiesAbility to translate complex regulatory requirements into practical operational guidanceStrong judgment balancing compliance risk against business growth objectives within a dynamic executive environmentExcellent written and verbal communication with both legal and non-legal stakeholdersHigh integrity and discretion handling sensitive topics and investigationsBenefitsComprehensive benefit options include medical, dental and vision, 401K and PTO.CompensationCompensation is commensurate to compensation for similar positions in the region and based on prior training and experienceJob Type: Full-timeJob SummaryRequisition Number: SENIO Job Category: LegalSchedule: Full-Time