Senior Regulatory Guidance Analyst

Company :

Highmark Health

Job Description : 

JOB SUMMARY

This job is responsible for the intake and review of material in support of a broad range of frameworks including NIST, HITRUST, PCI, HIPAA, SOC, MAR, CMS, JCAHO, NCQA, the BCBSA, etc., in addition to owning projects and initiatives related to the risk identification, intake, and interpretation activities of Highmark Health.  The incumbent will engage with the organizational risk and business partners, the technology organization, and global delivery teams to meet Highmark Health’s mission requirements in a manner consistent with the enterprise risk appetite.  Incumbent must have a proactive mindset and approach, and feel comfortable working in a highly matrixed environment.  

ESSENTIAL RESPONSIBILITIES

• Lead project and initiatives involving a global team of specialists. Identify, develop, coordinate, and implement legislative, regulatory, sub-regulatory, and licensing / accreditation requirements.  Perform ongoing monitoring and analysis of external regulatory and industry intelligence, collaborating with impacted stakeholders, and providing regular, executive summaries/abstracts to Risk Partners, Business Unit leadership, and/or the Audit Committee of the Board of Directors as required.
• Standardize, expand, and centralize the identification and ingestion of legislative, regulatory, sub-regulatory, and licensing / accreditation requirements through collaboration with Business Units accountable for government affairs, regulatory affairs, and/or regulatory readiness, and Legal Counsel to account for the completeness and accuracy of requirements. 
• Monitor and analyze regulatory and sub-regulatory developments, industry periodicals, and to determine the impact of enterprise/corporate related state and federal statutes, and regulations.
• Contribute knowledge to meetings with stakeholders and industry groups to remain up to date on industry trends and patterns.  Collaborate with Lead Analyst on his/her meetings with Government Affairs and key internal/external stakeholders to identify impacted policies, procedures, processes and technology from pending legislation and regulation.
• Supporting and providing regulatory expertise to assigned business units to initiate the implementation of assigned legislative, regulatory, sub-regulatory, and licensing / accreditation requirements.
• Leverage analytics programs, decision support systems, and standards that apply to complex information sets in order to make logical and supported risk & regulatory implementation recommendations.

• Other duties as assigned or requested.

EDUCATION

Required

• Bachelor's degree in Accounting, Finance, Business Administration/Management, Information Technology, Pre-Law, Computer,  Information Science, or related field

Substitutions

• 6 years of related and progressive experience in lieu of Bachelor's degree

Preferred

• Master's degree in Accounting, Finance, Business Administration/Management, Information Technology, Pre-Law, Computer,  Information Science, or related field

EXPERIENCE

Required

• 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

Preferred

• None

LICENSES or CERTIFICATIONS

Required

• None

Preferred (any of the following)

• Certified Public Accountant (CPA)

• Certified Information Systems Auditor (CISA)

• Juris Doctor (JD)

• PharmD

• Registered Nurse (RN)

SKILLS

• 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 

• 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 v