Highmark Health Senior Compliance Analyst - Medicaid in Pittsburgh, Pennsylvania

Description

JOB SUMMARY

This job partners with business units to ensure compliance to rules, regulations, policies, and procedures of governmental, contractual, and/or corporate entities. Provide consultation and analytic support to assigned functional areas. Continuously monitors regulatory changes, legislative efforts, industry trends, and/or contract changes.

ESSENTIAL RESPONSIBILITIES

  • Manage and coordinate compliance related processes.

  • Monitor governance and compliance of rules, regulations, policies, and procedures and assist with appropriate audits, as applicable. Contacts may include legislators, consumers, special interest groups, advocacy agencies, CMS and other regulatory bodies such as DPW.

  • Ensure systems are updated and accurate for compliance.

  • Responsible for understanding and applying accreditation and regulatory requirements. May support Regulatory Compliance department to ensure all state renewals, applications, and annual reports are completed accurately and timely.

  • Depending on department may be responsible for one of the following: the delegation oversight of subcontractors when applicable to ensure compliance with health plan standards and policies and regulatory bodies; performing and providing oversight of the care management delegation functions of multiple vendors through review of annual assessments, monthly performance reporting and analysis of reports to ensure adherence to regulatory and accreditation standards.

  • Other duties as assigned or requested.

QUALIFICATIONS:

Minimum

  • Bachelor's Degree

  • 5 years of relevant, progressive experience in the area of specialization

Preferred

  • Master’s Degree preferred

  • Experience in one or more of the following: healthcare operations, compliance, auditing, investigations, regulatory accreditation, process improvement, project management and/or managed care operations

Knowledge, Skills and Abilities

  • Strong written and oral communication skills.

  • Strong customer orientation with excellent interpersonal skills, including interview techniques, good judgment, initiative, and discretion in confidential or sensitive matters.

  • Self-starter with the ability to work under pressure independently and as part of a team.

  • Superior decision-making abilities under a variety of circumstances and creative thinking and effective risk mitigation abilities.

  • Strong process improvement and project management skills.

  • Strong analytical ability.

  • Demonstrated ability to effectively interact with all levels within the organization.

  • Proficiency with Microsoft Office software programs and database query tools, and other Internet and Intranet applications and databases.

REQNUMBER: J120354

Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity