Menu

Senior Risk & Compliance Case Manager

at Highmark Health in Augusta, Maine, United States

Job Description

Company :

Highmark Health

Job Description :

JOB SUMMARY

This job is responsible for leading and/or contributing to 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 engage as needed 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

+ Leads projects or initiatives involving global teams 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.

+ Leads projects or initiatives related to the program 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, engages senior Business Unit leadership and removes barriers for outside parties.Prepares and/or provides status reporting to Risk Partners, accountable management, and the Audit Committee of the Board of Directors as necessary.

+ Takes part in projects or initiatives 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.

+ Takes part in 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 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)

+ Strongrelationship 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.

Pay Range Minimum:

$57,700.00

Pay Range Maximum:

$106,700.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

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

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated\files/employers/poster\screen\reader\optimized.pdf )

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 number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Pr

To view full details and how to apply, please login or create a Job Seeker account
How to Apply Copy Link

Job Posting: JC229471815

Posted On: Nov 30, 2022

Updated On: Feb 08, 2023

Please Wait ...