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Director, Program Integrity - NY

extra holidays - extra parental leave - fully flexible

Remote:

Full Remote

Contract:

Full time

Experience:

Senior (5-10 years)

Work from:

Albania, New York (USA), United States

Offer summary

Qualifications:

Bachelor's degree required, 5+ years in compliance leadership, Experience with fraud and audit management, Knowledge of Medicaid preferred.

Key responsabilities:

Oversees fraud waste and abuse management
Manages external audits and regulatory relationships

Public Partnerships Financial Services SME https://www.pplfirst.com/

501 - 1000 Employees

See more Public Partnerships offers

Job description

Public Partnerships LLC (PPL) helps people with disabilities, chronic illnesses, or other long-term health conditions stay at home and “self-direct” their care. Known as consumer direction in New York, this long-term care model empowers people to take control of who provides their services and where. PPL was selected to be the Statewide Fiscal Intermediary for the New York Consumer Directed Personal Assistance Program (CDPAP) starting in 2025. We, along with a diverse alliance of service partners across the state, will be supporting the delivery of culturally sensitive and disability competent care to CDPAP participants. We are looking for people who share our passion for helping New Yorkers live happy, healthy, and independent lives to support CDPAP consumers and their personal assistants across a broad spectrum of services and functions.

Our culture attracts and rewards people who are compassionate, results-oriented, and driven to exceed customer expectations. We desire motivated candidates who are excited to join our fast-paced, consumer-focused environment, and who want to make a difference in helping transform the lives of the people we serve.

Learn more about PPL and CDPAP at https://pplfirst.com/cdpap.

Duties & Responsibilities:
Oversees the company’s fraud waste and abuse management program. Reviews available data to identify aberrant billing practices, unauthorized billings and payments, timesheet falsification, fraudulent cashing of checks. Monitors pended timesheets Conducts period random sampling of service limits, wage rates and other controls. Manages external audits conducted by state agency client, by health plan clients and by enforcing agencies. Engages in continual audit preparation. Prepares for specific communicated audits Engages with auditors and ensures prompt, accurate audit response. Reviews audit findings when applicable. Ensures that identified remedial actions are implemented and monitored. Manages the company’s relationships with regulatory authorities and external auditors. Prepares recommendations for operational, strategic and policy changes as a result of external audits. Recommends internal audit activities as needed, and manages internal audits. Manages the company’s response to suspected fraud waste and abuse incidents. Manages the company’s response to suspected incidents of abuse, neglect and exploitation of consumers. Collaborates with cross-functional teams, including legal, finance and operations, to ensure alignment of compliance efforts with business objectives Monitors regulatory developments and changes in the compliance landscape and advises company leadership accordingly. Provides regular reporting and updates on compliance activities, issues and trends to company leadership Acts as a champion for a culture of compliance and ethical conduct throughout the organization
Required Skills:
Excellent knowledge of relevant laws, regulations and industry standards Ability to communicate complex compliance issues clearly and effectively Strong analytical, interpersonal, and organizational skills. Proficiency in Microsoft Office technology. Demonstrated competence in reviewing contracts and other legal and regulatory documents. Strong attention to detail. Excellent written and oral communication skills. Strong work ethic and ability to prioritize tasks in a fast-paced, dynamic environment.
Qualifications:
Education:	Bachelor’s degree required. JD or advanced degree preferred
Experience:	5+ years of relevant work experience in a compliance leadership role required Experience with fraud waste and abuse prevention and management. Experience managing regulatory relationships and audits required Experience with government contracts and familiarity with Medicaid preferred
Working Conditions:
Remote setting This position is remote in NY. Candidates must reside in the state of NY to be considered.


The above is intended to describe the general contents and requirements of work being performed by people assigned to this classification. It is not intended to be construed as an exhaustive statement of all duties, responsibilities, or skills of personnel so classified.

Public Partnerships is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PPL, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PPL will not tolerate discrimination or harassment based on any of these characteristics.