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Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job partners with business units to ensure compliance to rules, regulations, policies, and procedures of governmental, contractual, and/or corporate entities. Provide consultation and analytic support to assigned functional areas. Continuously monitors regulatory changes, legislative efforts, industry trends, and/or contract changes.

ESSENTIAL RESPONSIBILITIES

+ Manage and coordinate compliance related processes.

+ Monitor governance and compliance of rules, regulations, policies, and procedures and assist with appropriate audits, as applicable. Contacts may include legislators, consumers, special interest groups, advocacy agencies, CMS, state Medicare/Medicaid administrators, and other regulatory bodies such as DPW.

+ Ensure or participate in ensuring that systems are updated and accurate for compliance.

+ Responsible for understanding and applying accreditation and regulatory requirements. May support Regulatory Compliance department to ensure all state renewals, applications, and annual reports are completed accurately and timely.

+ Depending on department may be responsible for one of the following: the delegation oversight of subcontractors when applicable to ensure compliance with health plan standards and policies and regulatory bodies; performing and providing oversight of the care management delegation functions of multiple vendors through review of annual assessments, monthly performance reporting and analysis of reports to ensure adherence to regulatory and accreditation standards.

+ Other duties as assigned or requested.

QUALIFICATIONS:

Education

+ Bachelor's Degree or relevant experience and/or education as determined by the company in lieu of Bachelor’s degree

Experience

+ 5 years of relevant, progressive experience in the area of specialization

Preferred

+ Master’s Degree

+ Experience in one or more of the following: healthcare operations, compliance, auditing, investigations, regulatory accreditation, process improvement, project management and/or managed care operations

Knowledge, Skills and Abilities

+ Strong written and oral communication skills.

+ Strong customer orientation with excellent interpersonal skills, including interview techniques, good judgment, initiative, and discretion in confidential or sensitive matters.

+ Self-starter with the ability to work under pressure independently and as part of a team.

+ Superior decision-making abilities under a variety of circumstances and creative thinking and effective risk mitigation abilities.

+ Strong process improvement and project management skills.

+ Strong analytical ability.

+ Demonstrated ability to effectively interact with all levels within the organization.

+ Proficiency with Microsoft Office software programs and database query tools, and other Internet and Intranet applications and databases.

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

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:

$50,200.00

Pay Range Maximum:

$91,200.00

_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: J272561