Regulatory Implementation and Assurance Analyst - Audit Oversight

Highmark Health; Pittsburgh (Allegheny County); On-site; USD 90,000 - 130,000; Full time

Job summary

Highmark Inc. is seeking a Regulatory Compliance Analyst to support intake, implementation, and assurance across HIPAA, HITRUST, PCI, CMS, and related frameworks. You will partner with risk and technology teams to meet enterprise risk appetite and coordinate with a global delivery network.

Ideal candidates bring 3+ years with regulators/auditors and strong communication skills for senior leaders, plus familiarity with healthcare regulatory guidelines and risk assessments.

Qualifications

• Bachelor's degree is required; substitutions allowed with 6 years of related and progressive experience.
• 3 years of interacting with regulators, auditors, or oversight bodies.
• Healthcare industry experience preferred.
• CPA or CISA certifications are preferred.
• Strong written and verbal communication for diverse audiences.

Responsibilities

• Coordinate with impacted departments to identify changes to policies, procedures, processes, and technology based on regulatory requirements.
• Translate regulatory requirements into business and technical specs for stakeholders and systems.
• Provide regular executive summaries to Risk Partners, Leadership, and Audit Committee as needed.
• Develop and execute regulatory implementation strategies across jurisdictions, assessing impact on people, processes, and tech.
• Support external audits ensuring agreements, compliance with laws, data accuracy, and minimal disruption.

Skills

Regulatory compliance

Risk management

Communication skills

Analytical thinking

Stakeholder management

Education

Bachelor's degree in Accounting, Finance, Business Administration/Management, IT, Pre-Law, CS, or related field

Job description

Company : Highmark Inc.

Job Summary

This job is responsible for supporting the work of the department projects and initiatives related to the regulatory intake, implementation, and assurance 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 Senior Analyst and Lead analyst to support their work 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

• Take part in 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.
• 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 None

Experience

Required 3 years of interacting with regulators, auditors, and/or oversight bodies 3 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)

Skills

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

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. 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. California Consumer Privacy Act Employees, Contractors, and Applicants Notice Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.