Overview
This role provides senior legal advisory support for healthcare compliance across the organization’s value-based care operations. The Senior Counsel, Healthcare Compliance guides fraud and abuse compliance and regulatory matters tied to multi-specialty and risk-based care arrangements, partnering closely with the General Counsel and Compliance function to support program integrity as the organization expands its national clinical footprint.
Responsibilities
- Provide strategic guidance to executives and support internal policy development aligned with the organization’s value-based mission, in partnership with the General Counsel
- Advise on compliance requirements for CMS risk-based models the organization participates in, including ACO REACH, the LEAD Model, MSSP, MA, and other shared savings arrangements
- Advise on key healthcare compliance frameworks, including the Stark Law, the Anti-Kickback Statute, the False Claims Act, state fraud and abuse laws, HIPAA, and similar statutory and regulatory requirements
- Partner with the Partnership/Affiliate team to craft payment models and support affiliate adherence to applicable law
- Monitor and interpret CMS regulations impacting value-based reimbursement models (ACOs, shared savings, risk-based contracts)
- Draft and update compliance policies and develop strategies related to coding, billing, and documentation focus areas across specialty service lines (podiatry, endocrinology, cardiology, vascular, chronic care management), including assistance with 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 focused on regulatory risk areas
- Serve as a resource for ad hoc frontline compliance questions across markets
Requirements
- 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
Preferred Qualifications / Desired Qualities
- Ability to translate complex regulatory requirements into practical operational guidance
- Strong judgment balancing compliance risk with business growth objectives in a dynamic executive environment
- Excellent written and verbal communication with both legal and non-legal stakeholders
- High integrity and discretion when handling sensitive topics and investigations
Compensation & Benefits
- Benefits: comprehensive medical, dental and vision; 401K and PTO
- Compensation: commensurate to compensation for similar positions in the region and based on prior training and experience
Job Type
Full-time
Equal Opportunity Employer
Equal Opportunity Employer. This employer is required to notify all applicants of their rights pursuant to federal employment laws.