Clinical Lead, Risk Management

4 weeks ago


Seattle, United States Headway - Design & Development Full time

As a Clinical Lead (Risk Management team), you will be responsible for executing and evolving Headway’s internal Provider Risk Management program, including investigations into Fraud, Waste, and Abuse, and associated provider remediation and coaching. You’ll also work cross-functionally with our Product, Operations, and CX teams to shape product development to align with our key initiatives.

As the only tech-enabled behavioral health Managed Services Organization (MSO) built with entirely in-house software, Headway has an unprecedented opportunity in the clinical space. Today, we support more than 26k Clinicians and hundreds of thousands of patients. Building a best-in-class digital product will impact clinicians and patients nationwide.

You Will:

Evaluate and improve Headway’s coding and billing policies, ensuring compliance with all Payer, state and federal regulations

Implement the process and policies associated with managing Fraud, Waste, Abuse at Headway

Review claims filing data to identify patterns to inform our internal coding policies

Have boots on the ground, working directly with Providers to educate them and change behavior in service of improving compliance

Ensure the quality and accuracy of our internal audit team

Support continuous and scalable auditing processes

Work closely with cross-functional teams to partner on policy changes and rollout in service of reducing fraud, waste, and abuse

Collaborate with our product and engineering teams to ensure our tools and systems are optimized for compliant coding and documentation behavior

Contribute to strategic planning, direction, and goal setting for the Provider Operations team

You’ll be great for this role if:

You have 3+ years of clinical operations/administration experience in areas such as quality improvement, utilization management, compliance or related experience in behavioral health

You are a licensed behavioral health clinician

You are a thought leader – with demonstrated passion for reimagining how provider performance is measured, identified, and resolved.

You are a collaborator – eager and adept at working in concert with product, operations, and sales teams to infuse clinical strategy across the org

You have cross-functional experience - working with interdisciplinary teams from Legal to Compliance to Product or Engineering

Nice to have:

Experience at a high-growth technology start-up

You are maintaining a small practice

You have experience in merging technology and healthcare

You are a certified expert coder - AHIMA or AAPC

Compensation and Benefits:

Salary information is based on a single salary target per role and is differentiated based on geographic location (Group A, B, or C)

Group A: $150,000

Group B: $135,000

Group C: $120,000

Examples of cities located in each Compensation Grouping:

Group A = NYC/Tri-State Area, SF/Bay Area, LA Area, Seattle, Boston, Austin, and San Diego

Group B = Chicago, Miami, Denver, Washington DC, Philadelphia, Atlanta, Minneapolis, Nashville, Sacramento, Phoenix, and Portland

Group C = All remaining cities

Benefits offered include:

Equity Compensation

Medical, Dental, and Vision coverage

HSA / FSA

401K

Work-from-Home Stipend

Therapy Reimbursement

16-week parental leave for eligible employees

Carrot Fertility annual reimbursement and membership

13 paid holidays each year as well as a Holiday Break during the week between December 25th and December 31st

Unlimited PTO

Employee Assistance Program (EAP)

Training and professional development

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