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Headway

Manager, Provider Risk Management

Posted 5 Hours Ago
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Remote
Senior level
Easy Apply
Remote
Senior level
The Manager of Provider Risk Management will lead the internal Provider Risk Management program, focusing on fraud, waste, and abuse, and will work with various teams to enhance coding policies and ensure compliance. Responsibilities include managing a clinical team, overseeing audits, developing policies, and collaborating on product development to improve mental healthcare practices.
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Headway’s mission is a big one – to build a new mental health care system everyone can access. We’ve built technology that helps people find great therapists with the first software-enabled national network of providers accepting insurance. 

1 in 4 people in the US have a treatable mental health condition, but the majority of providers don’t accept insurance, making therapy too expensive for most people. Headway is building a new mental healthcare system that everyone can access by making it easy for therapists to accept insurance and scale their practice. 

Headway was founded in 2019. Since then, we’ve grown into a diverse, national network of over 45,000 mental healthcare providers across all 50 states who run their practice on our software and have served over 1 million patients. We’re a Series D company with over $325m in funding from a16z (Andreessen Horowitz), Accel, GV (formerly Google Ventures), Spark Capital, Thrive Capital, Forerunner Ventures and Health Care Service Corporation.

We want your time here to be the most meaningful experience of your career. Join us, and help change mental healthcare for the better.

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

#LI-AR1

We believe a team's strength is in its people, and we cannot achieve this mission without a team that reflects the diversity of this problem – across race, ethnicity, gender, sexuality, age, national origin, religion, family status, disability, military status, and experience.

Headway is committed to the full inclusion of all qualified individuals. As part of this commitment, Headway will ensure that persons with disabilities are provided with reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or receive other benefits and privileges of employment, please contact [email protected]

Headway employees work remotely across the US, with the option to work from offices in New York City and San Francisco. Headway participates in E-Verify. To learn more, click here.

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