Clinical Integrity Specialist

Alma•Angle, MN

3h•Remote

About The Position

As a Specialist on the Clinical Strategy & Integrity Team, you will play an active role in our ability to sustain excellent clinical quality and contract compliance through our next phase of hypergrowth as we support in-network mental healthcare. You will serve as a subject matter expert on both the Alma product and Alma Integrity Standards, our conduct and fraud monitoring program. In this role, you will handle escalations, provide workflow support, and build business processes. The ideal candidate has an eye for detail, is an excellent communicator and project manager, as well as passionate about improving access to quality mental healthcare.

Requirements

2-3 years working in a customer experience, operations, strategy, or compliance-related role.
You have been at Alma for 9+ months and are in good standing in your role.
You are comfortable working with computer systems including Google Suite; experience with CRM and PM project management tools like Zendesk and Asana a huge plus.
You are able to break down complex and escalated communications into clear next steps for both cross-functional partners, providers, and internal stakeholders.
You are a creative thinker and problem solver— you’re constantly exploring how to make something even better or work through issues that require on-the-fly prioritization.
You are a highly organized team player and have a customer-centric attitude.
You have a demonstrated ability to handle change and communications around sensitive issues with composure.
You have cultural humility, can build relationships across differences, and have excellent interpersonal communication skills. You can work with stakeholders across levels.
You consistently use your strong attention to detail to routinely identify trends, pull insights, and provide clear constructive feedback.
You are passionate about our 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 (e.g. expansion, product features) 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.

Benefits

Health insurance plans through Cigna (medical and dental) and MetLife (vision), including FSA & HSA plans
401k plan (Roth and traditional)
Free Alma platform access
Monthly therapy and wellness stipends
Monthly co-working space membership stipend
Monthly work-from-home stipend to power your wifi, lunches, coffee, etc
Pet discount program through United Pet Care
Financial perks and rewards through BenefitHub
Free EAP access through LifeWorks
One-time home office stipend to set up your home office
Comprehensive parental leave plans
9 paid holidays, 1 Alma Mental Health Day, and 1 Alma Volunteering Day
Flexible PTO