Senior Regulatory Implementation and Assurance Analyst

Highmark Health / AHN; Pittsburgh (Allegheny County); On-site; USD 110,000 - 170,000; Full time

Job summary

Highmark Health in Pittsburgh seeks a senior risk and compliance program leader to drive large projects related to risk case management and intake, aligning with NIST, HITRUST, PCI, HIPAA, and other standards.

You will partner with risk partners, technology teams, and delivery groups to translate regulatory requirements into actionable business and technical needs, managing audits and streamlining risk intake across the enterprise.

Qualifications

• Bachelor's degree in Accounting, Finance, Business Administration/Management, Information Technology, Pre-Law, Computer, Information Science, or related field
• 6 years of related and progressive experience in lieu of Bachelor's degree
• Master's degree in Accounting, Finance, Business Administration/Management, Information Technology, Pre-Law, Computer, Information Science, or related field

Responsibilities

• Lead large team projects or initiatives involving a global team of specialists and coordinate with impacted departments to identify changes
• Create and execute complex regulatory implementation strategies across multiple jurisdictions
• Support external audits ensuring appropriate agreements and compliant information release
• Standardize documentation and tracking of audits and regulatory reviews and provide status reporting
• Standardize and expand internal and external risk intake and provide a streamlined point of entry for risk tracking

Skills

Regulatory knowledge

Project leadership

Communication skills

Stakeholder management

Regulatory frameworks

Healthcare knowledge

Education

Bachelor's degree in related field

6 years experience in lieu of degree

Master's degree preferred

Job description

## 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)
• - Strong 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: 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