Company :Highmark Health
Job Description :
This job is responsible for the intake and review of material in support of a broad range of frameworks including NIST, HITRUST, PCI, HIPAA, SOC, MAR, CMS, JCAHO, NCQA, the BCBSA, etc., in addition to owning projects and initiatives related to the risk identification and intake activities of Highmark Health. The incumbent will engage 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. Incumbent must have a proactive mindset and approach, and feel comfortable working in a highly matrixed environment.
Leads day to day projects or initiatives involving global team of specialists monitoring external regulatory and industry intelligence, including changes to laws, licensing and accreditation requirements, and regulations across numerous sources, coordinating with impacted departments to identify necessary changes to policies, procedures, processes, and technology and providing regular, executive summaries/abstracts to Risk Partners, Business Unit leadership, and/or the Audit Committee of the Board of Directors as required.
Leads projects or initiatives related to the enterprise program to standardize and expand internal and external risk intake (hotlines, inboxes, self-service, inquiries, vendor pipeline, incident & problem management systems, strategic initiative portfolio, etc.), providing a streamlined, consistent point of entry for risk tracking, assessment, treatment, and monitoring for all of Highmark Health.
Contributes to projects or initiatives related to the analytic program, decision support systems, and standards to apply to complex information sets in order to make logical and supported risk & regulatory recommendations.
Contribute knowledge to meetings with stakeholders and industry groups to remain up to date on industry trends and patterns. Collaborates the Lead Analyst on his/her rmeetings with Government Affairs and key internal/external stakeholders to identify impacted policies, procedures, processes and technology from pending legislation and regulation.
Other duties as assigned or requested.
- 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
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
LICENSES or CERTIFICATIONS
Preferred (any of the following)
Certified Public Accountant (CPA)
Certified Information Systems Auditor (CISA)
Juris Doctor (JD)
Registered Nurse (RN)
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
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)
Exhibits 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)
Strong capacity to think analytically, interpret information / observations, apply judgment and make effective, strategic decisions
Language (Other than English):
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
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 their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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 their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
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