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Company :

Highmark Health

Job Description :

JOB SUMMARY

This job is responsible for leading large projects and initiatives related to the risk case management and intake activities of Highmark Health in support of a broad range of frameworks and oversight bodies including NIST, HITRUST, PCI, HIPAA, SOC, MAR, CMS, JCAHO, NCQA, the BCBSA, etc. The incumbent will partner 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. The incumbent must have a proactive mindset and approach, and feel comfortable working in a highly matrixed environment.

ESSENTIAL RESPONSIBILITIES

+ Lead large team projects or initiatives involving a global team of specialists. Coordinate with impacted departments to identify necessary changes to policies, procedures, processes, and technology based on the identification of legislative, regulatory, sub-regulatory, and licensing / accreditation requirements from the Regulatory Guidance team;. Translate and communicate compliance requirements into business and technical requirements for impacted stakeholders and systems. Provide regular, executive summaries/abstracts to Risk Partners, Business Unit leadership, and/or the Audit Committee of the Board of Directors as required.

+ Create and execute complex regulatory implementation strategies for assigned legislative, regulatory, sub-regulatory, and licensing / accreditation requirements across multiple jurisdictions, including assessments of the regulatory impact of changes to people, processes, and technologies deployed across the enterprise.

+ Support all external audits of the organization, including ensuring that a) appropriate agreements are in place before the release of any information, b) the release of information is in accordance with applicable laws and organizational policies, c) information provided to the auditors is complete and accurate, d) chain of custody is maintained, and e) disruption to the daily operations of the Company is minimized.

+ Standardize documentation and tracking of audits, market conduct exams, regulatory reviews, and external accreditation assessments of the organization.During an audit, engage senior Business Unit leadership and removing barriers for outside parties.Prepare and/or provide status reporting to Risk Partners, accountable management, and the Audit Committee of the Board of Directors as necessary.

+ Standardize and expand internal and external risk intake (hotlines, inboxes, self-service, inquiries, vendor pipeline, incident & problem management systems, strategic initiative portfolio, etc.), and provide a streamlined, consistent point of entry for risk tracking, assessment, treatment, and monitoring for all of Highmark Health.

+ Implement policies and procedures to facilitate a consistent, high quality, confidential, and compliant service experience, including establishing service levels and requirements for the department and developing and implementing methods to record, assess, and analyze risk intake.

+ 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)

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

+ Excellent 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)

+ Strongrelationship 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)

+ 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 No...

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