Clinical Integrity Specialist
A
AlmaMental Healthcare
Remote, Contiguous USFull-TimeMiddle
Salary60,000 - 90,000 USD per year
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Job Details
- Experience
- 2-3 years
- Required Skills
- Google WorkspaceAsanaZendesk
Requirements
- 2-3 years working in a customer experience, operations, strategy, or compliance-related role
- Been at Alma for 9+ months and are in good standing in your role
- Comfortable working with computer systems including Google Suite
- Experience with CRM and PM project management tools like Zendesk and Asana (huge plus)
- Able to break down complex and escalated communications into clear next steps
- Creative thinker and problem solver
- Highly organized team player
- Customer-centric attitude
- Demonstrated ability to handle change and communications around sensitive issues with composure
- Cultural humility and ability to build relationships across differences
- Excellent interpersonal communication skills
- Strong attention to detail to routinely identify trends, pull insights, and provide clear constructive feedback
- Passionate about Alma's mission and making mental healthcare more accessible
Responsibilities
- Lead complex customer interactions and serve as a liaison between Alma providers and all Alma teams that encounter cases of fraud and misconduct by preparing escalation documents and executing various cross-functional workflows.
- Assist the Clinical Strategy & Integrity Team more broadly, in terms of provider education around Alma policies, procedures and tools, clients’ continuity of care, etc.
- Be a subject matter expert on all Alma’s products, services, and the broader organization to ensure compliance in the areas of credentialing, clinical decision-making, billing, membership and client experience.
- Surface trends and insights from the escalations you manage to ultimately bolster and sustain clinical quality throughout the organization and identify opportunities for improvement in operations and strategic initiatives.
- Maintain open communication channels with payers, specifically payer-affiliated care coordinators and risk managers.
- Keep the Clinical Strategy & Integrity team informed of more serious escalations by owning process documentation and keeping all documents up to date.
- Work closely with cross-functional partners on projects, processes, and launches that have implications for Alma Integrity Standards.
- Manage and improve our internal systems (e.g., Zendesk, Asana) and collaborate cross-functionally to improve how we work across teams.
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