Provider Risk Manager

Summary

Join Headway's Provider Risk Management team as a manager and lead the evolution of our internal program, investigating fraud, waste, and abuse. You will collaborate with cross-functional teams, develop policies, review claims data, educate providers, and oversee internal audits. This role requires 5+ years of clinical operations experience, at least 2 years of clinical supervision, and a license or certification. Headway offers a competitive salary based on location, equity compensation, comprehensive benefits including medical, dental, vision, 401k, and unlimited PTO. We are committed to building a diverse and inclusive team.

Requirements

• 5+ years of clinical operations/administration experience in areas such as quality improvement, utilization management, compliance or related experience in behavioral health
• At least 2 years experience in clinical supervision and/or managing a team
• A licensed behavioral health clinician OR are a certified expert coder/auditor (CPC, CPMA)

Responsibilities

• Manage and grow an established team of clinicians, CPCs, and operations analysts
• Evaluate and improve Headway’s coding and billing policies, ensuring compliance with all Payer, state and federal regulations
• Develop 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
• Oversee 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

Preferred Qualifications

• Experience at a high-growth technology start-up
• Maintaining a small practice
• Experience in merging technology and healthcare

Benefits

• Equity Compensation
• Medical, Dental, and Vision coverage
• HSA / FSA
• 401K
• Work-from-Home Stipend
• Therapy Reimbursement
• 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