Risk Partner

Highmark Health • Pittsburgh, PA

2d • Onsite

About The Position

This job is responsible for implementing, executing and maintaining the Compliance Program and its related policies to ensure the businesses act within the parameters of federal and state laws, regulations, and regulatory guidance. The incumbent is also responsible for the administration, interpretation, and enforcement of the Compliance Program including auditing/monitoring operational processes, conducting or overseeing compliance investigations, and ensuring that adequate training takes place under the Compliance Program. In this capacity, the individual is responsible for the collaborative and iterative execution of the risk and compliance plan for these entities across all areas in the enterprise risk taxonomy. Through matrixed leadership with Risk Operations and with support from Risk Enablement, the incumbent monitors and tracks the delivery of risk activities, including but not limited to, internal and external audit progress, recurring risk and compliance reporting, mandated training, investigations, and the impacts of new and changing laws, regulations, and contractual relationships. The incumbent must have extensive knowledge of the applicable federal and state rules as well as a solid working knowledge of managed care operations, compliance program structures, information security and audit methodologies. The incumbent must also have a foundational understanding of privacy regulations, including in-depth knowledge of HIPAA and possess the ability to perform a privacy risk assessment. The incumbent must have the highest level of integrity and ethics and demonstrate professional representation of the company.

Requirements

• Bachelor's Degree in Business, Finance, Health Administration, Public Health, Public Administration, Legal, Accounting or related field, or relevant experience and/or education as determined by the company in lieu of bachelor's degree
• 5 years in compliance, privacy, government affairs, healthcare operations, risk, audit, or legal functions
• 3 years in a leadership or management role
• Broad-based business knowledge as well as in-depth knowledge of the insurance industry, strategic compliance planning, regulatory concerns, compliance requirements, and corporate integrity principles
• Excellent oral, written, and presentation skills, as well as conceptual and analytic skills in order to review and articulate corporate objectives and regulations across all relevant audiences
• High-level of skill in leading interdepartmental and cross-functional strategy development
• Experience with managed care, Medicare and federal and/or state regulations, quality improvement and compliance oversight
• The ability to comprehend and interpret regulatory, legislative, and contractual mandates
• Experience managing multiple projects and managing professional staff on numerous projects to ensure corporate deadlines and objectives are met
• The utmost integrity in the discreet and confidential handling of confidential materials is necessary
• 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.
• Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct.

Nice To Haves

• Master's Degree in Business, Finance, Health Administration, Public Health, Public Administration, Legal, Accounting or related field
• 7 years in compliance, privacy, government affairs, healthcare operations, risk, audit, or legal functions
• 3 years experience in Healthcare Compliance or Privacy
• Certified Public Accountant (CPA)
• Certified Internal Auditor (CIA)
• Certified Fraud Examiner (CFE)
• Certified in Healthcare Compliance (CHC)
• Certified Compliance & Ethics Professional (CCEP)

Responsibilities

• Provides thought leadership and acts as an advisor to business leaders to ensure business decisions are made in alignment with the enterprise risk strategy / framework.
• Works with Risk Operations and the Strategic Risk Partner to implement and maintain an effective compliance and risk management program for the supported entities.
• Provide proactive guidance, education, and information to senior management, so that business leaders remain informed and aware of risks, requirements, mitigation strategies, and management’s responsibilities.
• Informs business entity of risk related activity, ensures awareness and monitors execution.
• Proactively identifies and addresses risk in partnership with Risk Operations, Legal, and business entity leaders by thoroughly understanding strategy and functional operation of the business entity.
• Respond to reports of potential or real instances of non-compliance including recommendations for resolution, risk treatment and corrective action plans.
• Liaise with external regulators or enforcement bodies interacting with the assigned business entity per defined communication and legal protocols.
• Ensure completion of all education and training initiatives and requirements and identify priorities for focus for the accountable entities.
• Participate in the implementation of the enterprise’s risk strategy for effective risk and compliance program governance; intended to strategically and proactively mitigate risk, and promptly detect and correct instances of non-compliance.
• Maintain a strong working knowledge of the regulatory, security, and privacy landscape.
• Other duties as assigned or requested.

Benefits

• HIPAA as described in the Notice of Privacy Practices and Privacy Policies and Procedures
• Privacy Policies and Procedures
• Privacy Policies and Practices
• Information Security Policy
• Company's Code of Business Conduct

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level