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Senior Compliance Analyst

Senior Compliance Analyst

Highmark HealthKissimmee, FL, US
1 day ago
Job type
  • Full-time
Job description

Highmark Inc.

Job Title : Compliance Partner

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, state Medicare / Medicaid administrators, and other regulatory bodies such as DPW.
  • Ensure or participate in ensuring that 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 : Education :

  • Bachelor's Degree or relevant experience and / or education as determined by the company in lieu of Bachelor's degree

    • Experience :

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

    • Preferred :

  • Master's Degree
  • 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.

    • Language (Other than English) : None

    Travel Requirement : 0% - 25%

    Physical, Mental Demands and Working Conditions :

    Position Type : Office-based

    Teaches / trains others regularly : Occasionally

    Travel regularly from the office to various work sites or from site-to-site : Rarely

    Works primarily out-of-the office selling products / services (sales employees) : Never

    Physical work site required : Yes

    Lifting : up to 10 pounds : Constantly

    Lifting : 10 to 25 pounds : Occasionally

    Lifting : 25 to 50 pounds : Rarely

    Pay Range Minimum : $50,200.00

    Pay Range Maximum : $91,200.00

    Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

    Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

    We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

    For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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    Senior Compliance Analyst • Kissimmee, FL, US