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Company :

Highmark Health

Job Description :

JOB SUMMARY

This job is responsible for the intake and review of material in support of a broad range of frameworks including NIST, HITRUST, PCI, HIPAA, SOC, MAR, CMS, JCAHO, NCQA, the BCBSA, etc., in addition to owning projects and initiatives related to the risk identification, intake, and interpretation activities of Highmark Health. The incumbent will engage with the organizational risk and business partners, the technology organization, and global delivery teams to meet Highmark Health’s mission requirements in a manner consistent with the enterprise risk appetite. Incumbent must have a proactive mindset and approach, and feel comfortable working in a highly matrixed environment.

ESSENTIAL RESPONSIBILITIES

+ Lead project and initiatives involving a global team of specialists. Identify, develop, coordinate, and implement legislative, regulatory, sub-regulatory, and licensing / accreditation requirements.Perform ongoing monitoring and analysis of external regulatory and industry intelligence, collaborating with impacted stakeholders, and providing regular, executive summaries/abstracts to Risk Partners, Business Unit leadership, and/or the Audit Committee of the Board of Directors as required.

+ Standardize, expand, and centralize the identification and ingestion of legislative, regulatory, sub-regulatory, and licensing / accreditation requirements through collaboration with Business Units accountable for government affairs, regulatory affairs, and/or regulatory readiness, and Legal Counsel to account for the completeness and accuracy of requirements.

+ Monitor and analyze regulatory and sub-regulatory developments, industry periodicals, and to determine the impact of enterprise/corporate related state and federal statutes, and regulations.

+ Contribute knowledge to meetings with stakeholders and industry groups to remain up to date on industry trends and patterns.Collaborate with Lead Analyst on his/her meetings with Government Affairs and key internal/external stakeholders to identify impacted policies, procedures, processes and technology from pending legislation and regulation.

+ Supporting and providing regulatory expertise to assigned business units to initiate the implementation of assigned legislative, regulatory, sub-regulatory, and licensing / accreditation requirements.

+ Leverage analytics programs, decision support systems, and standards that apply to complex information sets in order to make logical and supported risk & regulatory implementation recommendations.

+ Other duties as assigned or requested.

EDUCATION

Required

+ Bachelor's degree in Accounting, Finance, Business Administration/Management, Information Technology, Pre-Law, Computer,Information Science, or related field

Substitutions

+ 6 years of related and progressive experience in lieu of Bachelor's degree

Preferred

+ Master's degree in Accounting, Finance, Business Administration/Management, Information Technology, Pre-Law, Computer,Information Science, or related field

EXPERIENCE

Required

+ 5 years of interacting with regulators, auditors, and/or oversight bodies

+ 5 years of increasing accountability and/or progressive role, preferably in an Audit or Compliance discipline in a Healthcare or Healthcare related industry

Preferred

+ None

LICENSES or CERTIFICATIONS

Required

+ None

**Preferred** (any of the following)

+ Certified Public Accountant (CPA)

+ Certified Information Systems Auditor (CISA)

+ Juris Doctor (JD)

+ PharmD

+ Registered Nurse (RN)

SKILLS

+ Demonstrate knowledge of business and technology processes, risk and control frameworks, and assessment methodologies, particularly as applied to healthcare (payer and provider) business processes

+ Knowledge of relevant regulatory guidelines, vendor management, sourcing and procurement, and completing risk-based assessments

+ Resource and project planning capabilities, decision making skills, history of results-oriented delivery, and effective team building across a cross-campus and diverse team of management and staff

+ Strong written and verbal communication skills for diverse audiences (senior management, board, peer, and team)

+ Exhibits relationship building skills and ability to influence with and without authority in a matrixed organization. written and verbal communication skills for diverse audiences (senior management, board, peer, and team)

+ Strong capacity to think analytically, interpret information / observations, apply judgment and make effective, strategic decisions

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Frequently

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._

**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._

_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy._

_Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._

Pay Range Minimum:

$67,500.00

Pay Range Maximum:

$126,000.00

_Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at [email protected]

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID: J264195