Cloud and Things · 5 hours ago
Director, Program Integrity
United States
Full-time
Remote
Director/Executive
$130K/yr - $150K/yr
5+ years exp
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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.
Qualification
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Required
5+ years of relevant work experience in a compliance leadership role required.
Bachelor’s degree required.
Experience with fraud waste and abuse prevention and management.
Experience managing regulatory relationships and audits required.
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
Preferred
Experience with government contracts and familiarity with Medicaid preferred.
JD or advanced degree.
Driver's License (Preferred)
Company
Cloud and Things
Cloud and Things is an experienced State and Local Government IT consulting firms.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase
