Highmark Health
Senior Risk Partner - Compliance Officer
Highmark Health, Washington, District of Columbia, us, 20022
Overview Highmark Inc. job opening for a Compliance professional responsible for planning, designing, implementing, and maintaining the Compliance Program and its related policies to ensure the business acts within federal and state laws, regulations, and regulatory guidance. The incumbent will administer, interpret, and enforce the Compliance Program, including auditing/monitoring operational processes, conducting or overseeing compliance investigations, and ensuring adequate training under the Compliance Program. This role involves collaborative development of the risk and compliance plan across enterprise risk areas, monitoring and tracking risk activities, and coordinating with Risk Operations and Risk Enablement on audits, reporting, mandated training, investigations, and the impact of new laws, regulations, and contracts. A strong knowledge of federal and state rules, managed care operations, compliance program structures, information security, audit methodologies, and privacy regulations (including HIPAA) is required, with the ability to perform privacy risk assessments. The incumbent must demonstrate the highest integrity and ethics and represent the company professionally.
The full job description covers all associated skills, previous experience, and any qualifications that applicants are expected to have. Responsibilities
Matrixed working relationship with Risk Operations and Strategic Risk Partner to define the development, implementation and maintenance of an effective compliance and risk management program for the supported entities. This includes education and training requirements, reporting and intake protocols, monitoring and implementation of regulatory changes, risk assessment and audit execution, risk treatment plans, policy and procedure maintenance, response and investigation procedures, and compliance expectations.
Act as a thought partner and advisor to business leaders to ensure decisions align with the enterprise risk strategy/framework. Understand the business operations and strategy. Serve as a single point of contact for the business’ risks, compliance, privacy and security needs and partner with legal counsel on all efforts.
Provide proactive guidance, education, and information to senior management about risks, requirements, mitigation strategies, and management responsibilities. Lead discussions or presentations to existing Compliance or Risk Committees and the Audit & Compliance Committee meetings of the Board. Gather data and prepare reports for senior management and Board of Directors as needed. Ensure reporting obligations are met. Participate on risk committees and represent the entity as appropriate.
Inform business of risk-related activity, ensure awareness, and monitor execution. Track, monitor, and report on risk operations for the assigned Business Unit using standard metrics and reporting.
Identify and address risk in partnership with risk operations and legal functions, guided by business leadership. Serve as a single point of contact to respond to risk from the senior leadership team and triage follow-up protocols.
Participate in developing and implementing the enterprise’s risk strategy for governance of risk and compliance programs, including formal risk assessments and the annual audit plan.
Liaise with external regulators or enforcement bodies interacting with the assigned BU per defined communication and legal protocols.
Ensure completion of all education and training initiatives and prioritize focus areas for accountable entities.
Respond to reports of non-compliance, coordinate internal investigations, analyze facts, recommend resolutions, and develop risk treatment and corrective action plans. Work with legal counsel to ensure timely notice or disclosure as appropriate. Address all matters in a timely and responsible manner in compliance with corporate policy and applicable law.
Maintain a strong working knowledge of the regulatory landscape.
Other duties as assigned or requested.
Education
Required 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.
Preferred Master’s Degree in Business, Finance, Health Administration, Public Health, Public Administration, Legal, Accounting or related field
Experience
Required 7 years in compliance, privacy, government affairs, healthcare operations, risk, audit, or legal functions 5 years in a management or leadership role
Preferred 10 years in compliance, privacy, government affairs, healthcare operations, risk, audit, or legal functions 5 years in Healthcare Compliance or Privacy
Licenses or Certifications
Required None
Preferred (Any of the Following)
Certified Public Accountant (CPA) Certified Internal Auditor (CIA) Certified Fraud Examiner (CFE) Certified in Healthcare Compliance (CHC) Certified Compliance and Ethics Professional (CCEP)
Skills
Broad-based business knowledge and in-depth knowledge of the insurance industry, regulatory concerns, compliance requirements, and corporate integrity principles.
Excellent oral, written, and presentation skills with strong conceptual and analytic abilities to communicate objectives and regulations across audiences.
Ability to lead interdepartmental and cross-functional strategy development.
Experience with managed care, Medicare and federal/state regulations, quality improvement and compliance oversight.
Ability to interpret regulatory, legislative, and contractual mandates.
Experience managing multiple projects and leading professional staff to meet deadlines and objectives.
Highest integrity in discreet handling of confidential materials.
Language (Other than English):
None Travel
0% - 25%
Work Environment & Physical Demands
Office-based
Occasional teaching / training
Occasional travel between sites
Works primarily in an office setting
Physical lifting up to 25 pounds occasionally; lifting 10-25 pounds frequently
Disclaimer: The job description is intended to describe the general nature and essential duties. It may not include all duties required. Compliance Requirement: This job adheres to ethical and legal standards as set forth in company policy. HIPAA and data security obligations apply to all employees; refer to Company Privacy Policies and Information Security Policy. Employees must comply with the Code of Business Conduct and all applicable laws and policies. Pay Range Minimum:
$108,000.00 Pay Range Maximum:
$201,800.00 Base pay is determined by qualifications, experience, and other considerations. Salary ranges may vary by location. Highmark Health and its affiliates prohibit discrimination based on protected status and comply with applicable laws. For accessibility, contact HR Services Online at HRServices@highmarkhealth.org. California Consumer Privacy Act notice applies to employees, contractors, and applicants. Req ID: J267791
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The full job description covers all associated skills, previous experience, and any qualifications that applicants are expected to have. Responsibilities
Matrixed working relationship with Risk Operations and Strategic Risk Partner to define the development, implementation and maintenance of an effective compliance and risk management program for the supported entities. This includes education and training requirements, reporting and intake protocols, monitoring and implementation of regulatory changes, risk assessment and audit execution, risk treatment plans, policy and procedure maintenance, response and investigation procedures, and compliance expectations.
Act as a thought partner and advisor to business leaders to ensure decisions align with the enterprise risk strategy/framework. Understand the business operations and strategy. Serve as a single point of contact for the business’ risks, compliance, privacy and security needs and partner with legal counsel on all efforts.
Provide proactive guidance, education, and information to senior management about risks, requirements, mitigation strategies, and management responsibilities. Lead discussions or presentations to existing Compliance or Risk Committees and the Audit & Compliance Committee meetings of the Board. Gather data and prepare reports for senior management and Board of Directors as needed. Ensure reporting obligations are met. Participate on risk committees and represent the entity as appropriate.
Inform business of risk-related activity, ensure awareness, and monitor execution. Track, monitor, and report on risk operations for the assigned Business Unit using standard metrics and reporting.
Identify and address risk in partnership with risk operations and legal functions, guided by business leadership. Serve as a single point of contact to respond to risk from the senior leadership team and triage follow-up protocols.
Participate in developing and implementing the enterprise’s risk strategy for governance of risk and compliance programs, including formal risk assessments and the annual audit plan.
Liaise with external regulators or enforcement bodies interacting with the assigned BU per defined communication and legal protocols.
Ensure completion of all education and training initiatives and prioritize focus areas for accountable entities.
Respond to reports of non-compliance, coordinate internal investigations, analyze facts, recommend resolutions, and develop risk treatment and corrective action plans. Work with legal counsel to ensure timely notice or disclosure as appropriate. Address all matters in a timely and responsible manner in compliance with corporate policy and applicable law.
Maintain a strong working knowledge of the regulatory landscape.
Other duties as assigned or requested.
Education
Required 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.
Preferred Master’s Degree in Business, Finance, Health Administration, Public Health, Public Administration, Legal, Accounting or related field
Experience
Required 7 years in compliance, privacy, government affairs, healthcare operations, risk, audit, or legal functions 5 years in a management or leadership role
Preferred 10 years in compliance, privacy, government affairs, healthcare operations, risk, audit, or legal functions 5 years in Healthcare Compliance or Privacy
Licenses or Certifications
Required None
Preferred (Any of the Following)
Certified Public Accountant (CPA) Certified Internal Auditor (CIA) Certified Fraud Examiner (CFE) Certified in Healthcare Compliance (CHC) Certified Compliance and Ethics Professional (CCEP)
Skills
Broad-based business knowledge and in-depth knowledge of the insurance industry, regulatory concerns, compliance requirements, and corporate integrity principles.
Excellent oral, written, and presentation skills with strong conceptual and analytic abilities to communicate objectives and regulations across audiences.
Ability to lead interdepartmental and cross-functional strategy development.
Experience with managed care, Medicare and federal/state regulations, quality improvement and compliance oversight.
Ability to interpret regulatory, legislative, and contractual mandates.
Experience managing multiple projects and leading professional staff to meet deadlines and objectives.
Highest integrity in discreet handling of confidential materials.
Language (Other than English):
None Travel
0% - 25%
Work Environment & Physical Demands
Office-based
Occasional teaching / training
Occasional travel between sites
Works primarily in an office setting
Physical lifting up to 25 pounds occasionally; lifting 10-25 pounds frequently
Disclaimer: The job description is intended to describe the general nature and essential duties. It may not include all duties required. Compliance Requirement: This job adheres to ethical and legal standards as set forth in company policy. HIPAA and data security obligations apply to all employees; refer to Company Privacy Policies and Information Security Policy. Employees must comply with the Code of Business Conduct and all applicable laws and policies. Pay Range Minimum:
$108,000.00 Pay Range Maximum:
$201,800.00 Base pay is determined by qualifications, experience, and other considerations. Salary ranges may vary by location. Highmark Health and its affiliates prohibit discrimination based on protected status and comply with applicable laws. For accessibility, contact HR Services Online at HRServices@highmarkhealth.org. California Consumer Privacy Act notice applies to employees, contractors, and applicants. Req ID: J267791
#J-18808-Ljbffr