Regulatory Implementation and Assurance Analyst - Audit Oversight

Highmark; Pittsburgh (Allegheny County); On-site; USD 60,000 - 80,000; Full time

Job summary

A healthcare organization in Pittsburgh is looking for an analyst to manage regulatory compliance projects. You'll coordinate with departments, execute implementation strategies, and support audits. The role requires a Bachelor's degree or equivalent experience and at least 3 years in audit or compliance, particularly in healthcare. The ideal candidate possesses strong analytical and communication skills and the ability to work in a matrixed environment.

Qualifications

• 3 years of interacting with regulators, auditors, and/or oversight bodies.
• 3 years in an audit or compliance discipline in a healthcare-related industry.

Responsibilities

• Coordinate with departments to identify changes based on compliance requirements.
• Create regulatory implementation strategies across jurisdictions.
• Support external audits and ensure compliance.
• Standardize documentation for audits and reviews.
• Provide a streamlined point of entry for risk tracking.
• Leverage analytics for risk implementation recommendations.

Skills

Knowledge of business and technology processes

Risk and control frameworks

Verbal and written communication skills

Analytical thinking

Relationship building skills

Education

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

6 years of related experience in lieu of Bachelor's degree

Job description

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

Other Notes

• 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.

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.

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