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Clinical Lead, Risk Management - Seattle, United States - Headway - Design & Development
Description
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.
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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