Lead Compliance Analyst

Job ID: J117098
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Feb 21, 2018

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Description

GENERAL OVERVIEW:  

The Integrity & Compliance Analyst will provide analytical support to various aspects of the enterprise wide Integrity and Compliance Program. Responsible for assisting in the distribution of regulatory notices; maintaining various databases used for tracking of regulations, compliance issues, Code of Business Conduct and conflict of interest attestations, and training. Perform analysis, recommend changes to processes, and prepare reports. May be assigned monitoring, auditing and oversight activities and as such would be accountable for meeting project deadlines and deliverables.

ESSENTIAL RESPONSIBILITIES: 

1. Enterprise wide Integrity and Compliance Program Facilitation and Implementation

Collaborate with other members of the team and business owners, and provide experience to identify need for, develop, implement and promote integrity and compliance policies, procedures and programs to meet or exceed the integrity and compliance program requirements of:

  • The Federal Organizational Sentencing Guidelines
  • The Office of Inspector General’s Model Compliance Plan
  • The Centers for Medicare & Medicaid Services Part C and Part D program requirements and other government contract compliance requirements
  • Provide analytical support to risk identification and stratification, which includes monitoring and preparing reports in a proactive fashion.
  • Integrated Healthcare Delivery System compliance requirements (provider, Management Service Organization, Group Purchasing Organization)
  • International requirements for global roll-out to the Company’s international subsidiaries.

2. Investigate reported integrity and compliance concerns

 Support investigations to determine specifics and provide recommendations for resolution including allegations of unethical activities and violations of compliance standards.

3. Current trend and emerging integrity and compliance development

Monitor current compliance environment including corporate policies and procedures and other rules and regulations for integrity and compliance through trend analysis and risk assessment, taking appropriate steps to improve the Program’s effectiveness. (MCD Compliance only)

4. Integrity and Compliance training and education implementation

Support deployment and tracking of training for employees, managers, members of the boards of directors, and applicable first tier, downstream, and related entities.

5. Business owner collaboration and communication

  • Establish and maintain relationships with business owners in a variety of departments and subsidiaries within Highmark
  • Work closely with business owners throughout the enterprise to collaborate on key integrity and compliance initiative such as training, communication and the risk management strategy collaboration with Corporate Risk and Internal Audit.

6. Provide technical assistance as required

  • Demonstrate and apply a thorough understanding of Highmark’s complex business processes and environment
  • Demonstrate and apply strong project management skills, inspire teamwork and responsibility with team members, and use current technology and tools to enhance the effectiveness of deliverables
  • Basic understanding regulatory environment.

7. Other duties as assigned or requested.

QUALIFICATIONS:

Education, Licenses/Certifications, and Experience 

Minimum

  • Associate or Bachelor’s Degree or equivalent work experience
  • 7-10 years of related progress experience in the area of specialization including experience in leading projects of varying size and complexity. Grandfathered experience requirements effective August 2016.

Preferred

  • Bachelor’s degree

Knowledge, Skills and Abilities  

  • Basic understanding of model compliance programs, business and operational knowledge of Highmark and/or Insurance industry
  • Excellent oral, written, presentation, solid decision making abilities, and analytical skills to review and articulate corporate compliance objectives and applicable guidance and regulations
  • Strong interpersonal skills; must be able to effectively resolve conflicts Strong analytical and problem solving skills, sound professional judgment, business knowledge, and business acumen Strong organizational and project management skills Accountability for management of multiple projects with stringent and often overlapping deadlines involving several cross-functional areas. The incumbent interacts routinely with personnel within and outside of Highmark and must possess a positive, professional, and credible demeanor.  The utmost integrity in the discreet and confidential handling of confidential materials is expected. Possess the ability to assess operational functions and related reports to ensure compliance with applicable operational guidance and regulations.
  • Implementation and project deadline coordination must be routinely monitored for potential internal and external risks and reported to management. A constant balance between strict project deadlines, corporate initiatives and daily priorities must be maintained with critical attention to ensure compliance and corporate success.
  • Must be flexible and able to handle aggressive deadlines along with evolving priorities

SCOPE OF RESPONSIBILITY  

Does this role supervise/manage other employees?   

No 

   

WORK ENVIRONMENT

Is Travel Required?

Yes

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

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