At UpStream we believe good health is a state of independence where each person has the capacity to live a long, happy, and active life. We aim to deliver the type of care our members need to regain and maintain their independence by delivering effective, efficient, and sustainable care. We are a growing company and are excited to invite caring, detailed, and team-oriented people to join our team.

Who we are

UpStream is a trusted partner, helping to free up primary care physicians to focus on what is most valuable to them and their patients. We enable participation in advanced payment models through integrated clinical, financial and technology support and systems, while working to eliminate the burden of chronic disease. To achieve this, we embed a powerful support platform that facilitates physicians, pharmacists, and nurses to achieve the greatest recognition in value-based care so that patients can live longer, happier, and independent lives.

How you’ll help

As a member of the Legal and Compliance Department and a leader on the Compliance team, you will support the Chief Compliance Officer in developing and implementing UpStream’s ACO Compliance Program. In this role you’ll oversee day to day compliance of UpStream’s ACOs and will provide routine updates to the ACO Board setting forth all compliance activity. The ACO Board will be responsible for ensuring that the Compliance Program meets its stated goals and addresses the current regulatory environment and other issues impacting the healthcare industry.

What you’ll do

• Work closely with UpStream’s Chief Compliance Officer to direct communication and implementation of compliance goals, standards, and procedures throughout the ACO(s)
• Direct and coordinate compliance education and training
• Develop and implement alternative means of communication to allow improprieties to be reported without fear of retaliation and promote open communication with the Compliance Office for reporting and for clarification or questions regarding policies and compliance matters. The foregoing includes the adoption of a compliance toll free (confidential and anonymous) hotline as well as good faith reporting (whistleblower) and other policies
• Under the guidance of the Chief Compliance Officer, direct compliance activities between and among ACO, Affiliates and ACO employees, contractors, providers/suppliers, professionals, and participants
• Oversee investigation of suspected cases of illegal or improper activity within the ACO, Affiliates and ACO employees, contractors, providers/suppliers, professionals, and participants; recommend corrective steps as necessary
• May serve as the UpStream Privacy Officer, ensuring HIPAA standards and requirements are met and assist with revising, developing, and implementing organizational privacy policies and procedures
• May serve as the Compliance Officer of record for UpStream’s ACO subsidiaries
• Review ACO policies and procedures for consistency with standards, procedures, and goals of the Compliance Program
• Review Compliance Program annually, and make revisions as necessary
• Consistently exhibit behavior and communication skills that demonstrate UpStream’s commitment to quality healthcare
• Perform additional duties as required or assigned by the Chief Legal Officer, Chief Compliance Officer, or designee

Experience and skills you’ll need

• Bachelor's Degree is required with a degree in Business, Healthcare, or related field preferred
• Master’s Degree/Juris Doctorate preferred, but not required
• Excellent organizational, verbal, and written communication skills required
• Demonstrated expertise in Medicare/Medicare Advantage, general healthcare billing and coding practices, the federal Anti-Kickback Statute, False Claims Act, and other laws and regulations related to healthcare compliance
• 5+ years of experience in managed care, provider relations, payer relations, healthcare, project management or related field
• Basic computer skills and proficient knowledge in Microsoft Word, Excel and PowerPoint required
• Excellent attention to detail required

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

Job Keywords: ACO REACH, Compliance, Medicare, Healthcare, Pharmacy, Privacy, HIPAA