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Regulatory Implementation Specialist
2 months ago
This role is responsible for leading large projects and initiatives related to risk case management and intake activities of Highmark Health in support of various frameworks and oversight bodies. The incumbent will partner with organizational risk and business partners, technology organization, and global delivery teams to meet Highmark Health's mission requirements in a manner consistent with the enterprise risk appetite.
Key Responsibilities- Lead large team projects or initiatives involving a global team of specialists, coordinating with impacted departments to identify necessary changes to policies, procedures, processes, and technology based on regulatory requirements.
- Create and execute complex regulatory implementation strategies for assigned legislative, regulatory, sub-regulatory, and licensing/accreditation requirements across multiple jurisdictions.
- Support all external audits of the organization, ensuring that agreements are in place, information is released in accordance with applicable laws and organizational policies, and chain of custody is maintained.
- Standardize documentation and tracking of audits, market conduct exams, regulatory reviews, and external accreditation assessments of the organization.
- Implement policies and procedures to facilitate a consistent, high-quality, confidential, and compliant service experience, including establishing service levels and requirements for the department.
- Leverage analytics programs, decision support systems, and standards to make logical and supported risk & regulatory implementation recommendations.
- Bachelor's degree in Accounting, Finance, Business Administration/Management, Information Technology, Pre-Law, Computer/Information Science, or related field.
- 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.
- Master's degree in Accounting, Finance, Business Administration/Management, Information Technology, Pre-Law, Computer/Information Science, or related field.
- Certified Public Accountant (CPA), Certified Information Systems Auditor (CISA), or Juris Doctor (JD) certification.
- 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).
- Capacity to think analytically, interpret information/observations, apply judgment, and make effective, strategic decisions.
English (primary language); 0% - 25% travel requirement.
Physical, Mental Demands, and Working ConditionsOffice-based position; teaches/trains others regularly; frequently travels from the office to various work sites or from site-to-site.
