Highmark Health Compliance Officer in Pittsburgh, Pennsylvania
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.
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.
Bachelor's Degree – Business Administration, Healthcare Administration, Law or other related area
Master’s Degree – Business Administration or Healthcare
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
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
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
Certified in Healthcare Compliance (CHC)
0% - 25%
LANGUAGE REQUIREMENT ( other than English )?
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).
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
Travels regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (Sales employees)
Does Not Apply
Physical Work Site Required
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.
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
Lifting: 10 to 25 pounds
Does Not Apply
Lifting: 25 to 50 pounds
Does Not Apply
Changes Approved By:
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
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled