What are the responsibilities and job description for the Risk Management Lead position at Headway?
About The Role
As Headway’s Risk Management Lead, you will develop and own our company policy on Coding Compliance, and ensure the integrity of our billing function. You will also lead and evolve Headway’s internal Provider Risk Management program, overseeing the team’s investigations into Fraud, Waste, and Abuse. You’ll also work cross-functionally with our Product, Operations, and CX teams to shape product development to align with our compliance 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:
- Manage and grow an established team of clinicians, CPCs, and operations analysts
- Develop 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
- Ensure the quality and accuracy of our internal audit team
- Develop and implement 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’d be great for this role if:
- You have 9 years of utilization management or related experience in behavioral health, with at least 3 years of experience managing a team
- You are a licensed behavioral health clinician
- You are a thought leader – with demonstrated passion for reimagining how Provider Risk 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 experience supervising clinicians or large teams of providers, with an emphasis on performance management
- You have cross-functional experience - working with interdisciplinary teams from Legal to Compliance to Product or Engineering
- Nice to have:
- CCM certification
- 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: $180,000
- Group B: $162,000
- Group C: $144,000
- 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:
- 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
