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- Albany, NY
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Public Consulting Group • Albany, NY
Posted 4 days ago
Public Consulting Group, Inc. (PCG) provides management consulting and technology services to help public sector education, health, human services, and other government clients achieve their performance goals and better serve populations in need. Founded in 1986 and headquartered in Boston, Massachusetts, PCG has more than 1,700 professionals in 55 offices around the U.S. and in Montreal, UK and Poland. The firm draws on more than two decades of consulting to public sector clients in all 50 states and Canada to deliver best-practice solutions and measurable results to state and local public agencies, state-operated facilities, and private providers that do business with government agencies. PCG is committed to a diverse workforce which is a reflection of our clients and the people they serve. Our organizational culture attracts and rewards people who are results-oriented and interested in making an immediate impact on their community as well as their own career.
The Audit & Compliance Director is responsible for assisting the New York Department of Health (NYSDOH) to achieve the goals established through its Delivery System Reform Incentive Payment Program (DSRIP). The NYSDOH has launched a multi-year initiative designed to transform the way health services are delivered to New York State’s Medicaid members. Audit & Compliance Managers will be responsible for monitoring, reviewing, and reporting on the performance of participating provider networks, known as Performing Provider Systems (PPSs), who have committed to creating and sustaining an integrated, high performing health care delivery system by improving health and reducing costs.
- Manage and provide oversight over all audit functions surrounding the DSRIP program, including conducting risk assessments, performance audits, and financial compliance reviews of Performing Provider Systems (PPS). This work will include validating PPS performance against completed process milestones; conducting site visits to verify performance; and complete monthly/quarterly reports to calculate achievement values in order to determine DSRIP payments earned.
- Develop and standardize program and financial reviews of the DSRIP program, including developing protocols for onsite audits and training staff on policy and procedures.
- Manage and provide oversight over three Audit Leads and their team of staff on the completion of the Mid-point assessment review and ongoing monitoring on a specific number of PPSs.
- Plan, oversee, and manage PPS program and financial reviews under defined timeframes. Ensure consistency in review processes across all the teams and audits of the PPSs.
- Track status of audits across the three audit teams and PPSs.
- Assist in the design and development of the Mid-point assessment review plan and accompanying review tools.
- Draft reports and deliver on all the services the client has purchased or needs.
- Identify at-risk projects and providers in accordance with defined protocols.
- Be able to understand and use data to assess PPS performance.
- Track deliverables owed by PPSs and determine performance, as well as payments earned.
- Complete quarterly report results and tracking statewide performance.
- Assist in the preparation of program review training materials and staff development.
- Serve as lead client contact on all matters surrounding audit and program reviews.
- Additional responsibilities as assigned.
- Bachelors degree.
- Strong background and understanding of healthcare delivery systems, strong preference given to those candidates with experience working within the Medicaid program.
- Experience performing program and/or financial audits within the healthcare sector.
- Ability to work independently with minimal supervision.
- Ability to travel frequently within a defined geographic region within New York State.
- Work with colleagues to continuously improve monitoring processes.
- Excellent communication skills including business writing, and ability to make presentations to various audiences.
- Proactively work with Senior Managers and overall Project Manager to participate in client meetings to provide updates on progress and findings.
- Develop staff through coaching and mentoring; maintain high colleague morale throughout the engagement.
- Maintain security and confidentiality of all protected health information encountered during performance.
- Well organized with a high degree of accuracy and attention to detail.
- Must be able to learn a significant amount of information in a short time-frame.
- Effectively manage multiple deadlines and prioritize assignments.
- 10 years of relevant work experience required.
- 5+ years of supervisory experience.
- Possesses solid knowledge of audit and accounting in a variety of areas and has specialized industry knowledge (Medicare and Medicaid programs and reimbursement, Medicaid Managed Care, General Healthcare, etc.).
- Experience conducting on-site visits to provider locations.
- Proficient in use of applicable software programs, including Microsoft Word and Excel.