Manager, Provider Risk Management

About The Role

As a manager (Provider 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 40k clinicians and hundreds of thousands of patients. Building a best-in-class digital product will impact clinicians and patients nationwide.

You Will:

• 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

You'll be great for this role if:

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

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: $139,000
  • Group B: $125,900
  • Group C: $111,200
  • 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
  • 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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