Compliance Officer

Job ID: J125055
Company: Highmark Health
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Jun 13, 2018

Share:

Description

JOB SUMMARY 

This job is responsible for execution of a comprehensive, risk-based Integrity and Compliance program across all of the Organization's business operations, including subsidiaries and affiliates.  Assists in defining and implementing programs to ensure consistent standards of business conduct, ethical relationships and compliance in all aspects of company operations with customers, external vendors, government regulators, employees and the communities in which business is conducted.  Reports to the VP, Integrity & Compliance.  In addition to compliance program responsibilities, the incumbent is accountable to the Vice President of Integrity & Compliance for enterprise policy administration and learning governance.  This requires oversight of policy review and approval procedures, timely response to policy requests related to external audits and facilitation of policy related questions and concerns.   The incumbent is also accountable for the development and implementation of a governance structure overseeing mandated entity and enterprise training, to promote efficient and effective utilization of resources, and compliance with federal and state training requirements.

ESSENTIAL RESPONSIBILITIES 

  • Performs 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.
  • Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.
  • Oversees the required corporate functions of the Organization's Integrity & Corporate Compliance Department including but not limited to written standards, compliance and regulatory mandates, education and training, issue investigation and resolution, enterprise compliance and governance.
  • Leads the policy office in policy administration across the enterprise
  • Guides development and implementation of the learning governance process for the enterprise.
  • Other duties as assigned or requested including but not limited to participation on  committees and strategic projects, providing compliance and regulatory guidance and direction.

REQUIRED EDUCATION

Bachelor's Degree – Business Administration, Healthcare Administration, Law or other related area

Substitutions 

No Substitutions

PREFERRED EDUCATION

Master’s Degree – Business Administration or Healthcare

EXPERIENCE

Minimum: 

  • Healthcare industry experience, specifically insurance and/or health care provider knowledge and experience
  • 7-10 years' of progressive ethics and compliance-related experience, including knowledge of federal/state healthcare regulations
  • 5-7 years of leadership experience

Preferred: 

  • Compliance Officer experience for hospital or health system
  • Experience presenting to all levels of leadership including regular updates to the Board of Directors
  • Design and/or management of all components of a corporate compliance program

SKILLS

  • Experience with managed care, Medicare and Federal and/or State regulations, quality improvement and compliance oversight; and the ability to comprehend and interpret regulatory, legislative, and contractual mandates
  • Excellent oral, written, and presentation skills, as well as conceptual and analytic skills are necessary in order to review and articulate corporate objectives and Federal regulations across all relevant audiences
  • Compliance and/or regulatory experience with proven ability
  • Manage initiatives to ensure compliance with government regulations
  • Broad-based business knowledge as well as in-depth knowledge of the healthcare industry, strategic compliance planning, regulatory concerns, compliance requirements, healthcare trends, and Corporate Integrity principles
  • The utmost integrity in the discreet and confidential handling of confidential materials is necessary
  • High-level of skill in leading interdepartmental and cross-functional strategy development.  Experience managing multiple projects and managing professional staff on multiple projects to ensure corporate deadlines and objectives are met

REQUIRED LICENSURE 

None

PREFERRED LICENSURE

Certified in Healthcare Compliance (CHC)

TRAVEL REQUIREMENT:

0% - 25%

LANGUAGE REQUIREMENT (other than English)?  
None

PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
(The physical, mental demands and working conditions described here are representative of those that must be met by an employee to successfully perform the essential function of their job. Reasonable accommodations will be made when necessary to enable individuals with disabilities to perform the essential duties of the position, to the extent that they do not cause undue hardship).

Position Type:

Office-Based

Office-Based Positions

An employee in this position works in an office environment.  The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (e.g., in person, via telephone, via email).  The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks.  The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.

Teaches/Trains others regularly

Occasionally

Travels regularly from the office to various work sites or from site-to-site

Occasionally

Works primarily out-of-the office selling products/services (Sales employees)

Does Not Apply

Physical Work Site Required

Yes

Most On-The-Road Positions

An employee in this position may work in a home or company office environment but is also frequently driving to and from various locations to perform the work off-site.  The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (e.g., in person, via telephone, via email).  The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks.  The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.

Non-Office-Based Positions

An employee in this position is frequently required to move throughout the workplace, sit, stand and walk, use hands and fingers to hold objects, tools or controls, possess fine motor skills (e.g., to write and operate a computer or to steer transportation equipment), possess gross motor skills (e.g., to carry items), reach with hands and arms, climb stairs and ladders, balance, stoop, kneel crouch and crawl, communicate effectively, and talk and hear. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.  The employee must be able to work in a busy environment where decisions often must be made quickly, must attend work on a regular and reliable basis, must adhere to all workplace policies, and may be called upon to work outside regular business hours.  This work occurs in a [example: warehouse, hospital or provider’s office or mailroom].

Lifting: up to 10 pounds

Rarely

Lifting: 10 to 25 pounds

Does Not Apply

Lifting: 25 to 50 pounds

Does Not Apply

ADDITIONAL INFORMATION

Changes Approved By:

Jeff Cypher

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, 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.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.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 call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

Share:

Interested in working at the Highmark Health enterprise?
Take the first step by joining our Talent Network today!

Join Our Talent Network

Similar Jobs

Accreditation Consultant

Pittsburgh, PA, United States
Audit & Compliance

Accreditation Consultant

Pittsburgh, PA, United States
Audit & Compliance

Associate Fraud Analyst

Pittsburgh, PA, United States
Audit & Compliance

Director, Government Compliance

Pittsburgh, PA, United States
Audit & Compliance

Fraud Analyst-2

Camp Hill, PA, United States
Audit & Compliance

Internal Audit Analyst

Pittsburgh, PA, United States
Audit & Compliance

Senior Compliance Analyst

Pittsburgh, PA, United States
Audit & Compliance

Manager Compliance Audit

Pittsburgh, PA, United States
Audit & Compliance

Senior Compliance Analyst - Medicaid

Charleston, WV, United States
Audit & Compliance

IT Audit Analyst

Pittsburgh, PA, United States
Audit & Compliance

Sr Compliance Analyst

Pittsburgh, PA, United States
Audit & Compliance

Sr Compliance Analyst

Pittsburgh, PA, United States
Audit & Compliance

Mgr, Government Compliance

Little Rock, AR, United States
Audit & Compliance

Compliance Analyst - GHP

Pittsburgh, PA, United States
Audit & Compliance

Compliance Consultant

Pittsburgh, PA, United States
Audit & Compliance

Medicaid Compliance Consultant

Charleston, WV, United States
Audit & Compliance

Senior Compliance Analyst

Harrisburg, PA, United States
Audit & Compliance

Compliance Officer

Pittsburgh, PA, United States
Audit & Compliance

Compliance Auditor

Pittsburgh, PA, United States
Audit & Compliance

Compliance Analyst - GHP

Pittsburgh, PA, United States
Audit & Compliance

Lead Quality Assurance Consultant (Claims)

Harrisburg, PA, United States
Audit & Compliance

Lead Quality Assurance Consultant (Claims)

Camp Hill, PA, United States
Audit & Compliance

Lead Quality Assurance Consultant (Claims)

Pittsburgh, PA, United States
Audit & Compliance

Senior Compliance Analyst - Auditor

Pittsburgh, PA, United States
Audit & Compliance

Compliance Analyst - Auditor

Pittsburgh, PA, United States
Audit & Compliance