Manager Regulatory Implementation and Assurance Analyst

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

Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority. Manage a global team coordinating with impacted departments to identify necessary changes to policies, procedures, processes, and technology based on the identification of new regulatory (or sub-regulatory) compliance requirements from the Regulatory Guidance and Interpretation team. Translate and communicate regulatory 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. Manage a global team supporting 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. Manage an 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.), and provide a streamlined, consistent point of entry for risk tracking, assessment, treatment, and monitoring for all of Highmark Health. Develop and manage analytic programs, decision support systems, and standards to apply to complex information sets in order to make logical and supported risk & regulatory implementation recommendations. Manage and direct programs to standardize documentation and tracking of audits, market conduct exams, regulatory reviews, and external accreditation assessments of the organization. During the course of an audit, engage senior Business Unit leadership and removes barriers for outside parties. Oversee the team preparing and/or providing status reporting to Risk Partners, accountable management, and the Audit Committee of the Board of Directors as necessary. Administer and manage 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. 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 interaction with regulators, auditors, and/or oversight bodies

To Include:

3 years overseeing privacy, risk, quality, and/or compliance teams 3 years in a leadership 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 Information Systems Auditor (CISA) Juris Doctorate (JD) Certified Identity Protection Advisor (CIPA) SKILLS Demonstrate expert 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 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) Highly developed leadership qualities with an ability to motivate and inspire a group of individuals to achieve superior results High 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 Occasionally 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. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org 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.