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Government Compliance Liaison (PA Remote)

Highmark Wholecare

  • Company April 2022 Ed (1)
  • Pittsburgh, PA
  • Audit & Compliance
  • Full time
  • Day (United States of America)

Company :

Highmark Wholecare

Job Description : 


This job serves as the primary contact with state regulators and is responsible for program management of compliance related projects conducted by assigned business owners for state and federal regulatory requirements.  The incumbent maintains subject matter knowledge and expertise to educate and direct business owners regarding contractual requirements, demonstrates the ability to identify potential business impacts/compliance gaps across the organization and collaborates with and/or directs business owners on the development of solutions to mitigate risks. Reviews documentation developed by business owners to support compliance on an ongoing basis and coordinates representation/participation of the organization in state and federal committees, workgroups, studies, etc. and oversees fraud, waste & abuse monitoring, investigations and required reporting to state and federal authorities.


  • Serve as the primary contact for state and federal activities that are company-wide in nature and accountable for coordination of activities with multiple departments, business areas, external vendors and consultants.
  • Lead, coordinate and oversee the development, implementation and on-going monitoring and follow through for Medicaid compliance program initiatives.  Based on trends and issue identification, partner closely with business owners and organizational leaders to improve regulatory compliance, provide recommendations and ensure compliance measures are aligned, sustainable and operating effectively.  
  • Coordinate compliance operations with business units, including internal staff and/or external regulators to meet state and federal audit requirements.
  • Direct business owners and management across the organization on all aspects of regulatory requirements and delegation oversight. Specific to delegation oversight determination of delegation, support composition of agreement language, coordinate ongoing monitoring requirements, manage centralized reporting, and oversee remediation of identified risk.
  • Manage department-specific projects  to support ongoing compliance with regulatory requirements by:  developing and implementing work plans, obtaining status updates, reviewing outcomes, recommending changes (as needed), and working with the applicable business owner on finalization.
  • Provide ongoing direction and support to business owners and management on compliance matters and coordinate inquiries with external stakeholders/consultants to resolve complex compliance issues.
  • Chair/facilitate workgroups to ensure that compliance related matters are reported as required, direction/input is received from applicable subject matter experts, and adequate documentation is maintained.
  • Develop and monitor reporting matrices, compile and present reports/ audit documentation.
  • Other duties as assigned or requested.



  • Bachelor's Degree  in Business Administration, Accounting/Finance, Healthcare, Public Policy/ Pre-Law


  • Managed care experience including compliance, accreditation, regulatory, or operations.


  • Master's Degree in Business Administration, Accounting/Finance, Healthcare, Public Policy



  • 6 years of progressive compliance experience
  • 2 years of project management experience


  • Experience interacting with external regulatory representatives
  • Experience in one or more of the following: healthcare operations, compliance, aditing, investigations, regulatory accrediations, process improvement, and/or project management.
  • Medicare and/or Medicaid experience


  • Excellent verbal and written communication skills
  • Demonstrated ability to manage multiple and complex priorities
  • Demonstrated ability to work independently and take initiative
  • Demonstrated ability to meet compliance deadlines


Does this role supervise/manage other employees?



Is Travel Required?


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 position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

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. 

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Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( )

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