Senior Risk and Quality Assurance Analyst

Company :

Highmark Health

Job Description :

JOB SUMMARY

This job supports risk & quality assurance studies required by regulators, the Blue Cross Blue Shield Association (BCBSA), accreditation bodies, executive management, plan partners, group customers, and employee level performance. The programs for which the department is currently wholly or partially responsible for are (a) the BCBSA's Member Touchpoint Measures (MTM), Licensee Desk Level Audit (LDLA), and Federal Employee Program (FEP) Quality Program, (b) the National Committee for Quality Assurance (NCQA), (c) Joint Commission accreditation compliance, (d) quality measures required by state regulators, (e) certain quality measures related to group and partner plan contractual performance guarantees / service level agreements, and (f) employee performance quality.

ESSENTIAL RESPONSIBILITIES

• Plan and conduct risk assessment activities according to the appropriate framework, including but not limited to MTM, LDLA, FEP, state, and contractual in order to identify, assess, prioritize, evaluate and address compliance and other areas of risk.Prepare draft reports and other management reporting deliverables.Review all work prepared by less experienced team members to ensure audit quality standards are consistently met in all forms of documentation.

• Review and interpret inherent risk assessment results, engagement risks, and developassurance plans (e.g., on-site audit, contract review, financials assessment, purchasing data analysis) to address relevant risk areas and to ensure proper controls are implemented.Accountable for the review and interpretation of authoritative guidance and performs qualitative and quantitative impact assessments based on regulatory and contractual requirements; conducts additional information gathering and risk assessments as-needed; documents and reports results.

• Lead development of project plans to support risk assessment and decisioning in coordination with business owners and other stakeholders within task-based budgets.Collaborate and communicate with Operations, Sales, Provider, and other teams across the Enterprise to align risk management objectives, practices and procedures.

• Interface with business areas, technical staff, project teams, and third parties to execute cross-functional risk assurance projects. Lead the communication of assessment results and findings with multiple stakeholder groups and provides consultation and direction throughout.

• Interpret complex data flow/ information sharing activities, customer integrations, and information safeguards into simplified and high-level terminology and/or process/data flows.Maintains risk management reporting dashboards in RSA Archer applications in order to keep information complete, accurate, and current.Prepare and assist with the delivery of risk assurance reports to management.

• Ensure audit procedures and other risk assessments are distributed and completed on-time and prepare initial impact assessments.Ensure compliance requirements are met across the Enterprise.Assist in training and mentoring team members on multi-faceted engagements, platform customer dependencies, and interpretation of complex authoritative guidance.

• Collaborate with lead in providing input and consultation on risk and assurance reporting.Collaborate and consult with other areas (e.g., Procurement, Privacy, Information Security, Legal) throughout the engagement lifecycleAssist in providing timely feedback on interpretations regarding authoritative guidance.

• Proactively reviews updates made to departmental desk-level procedures, risk assessment methodology, assessment procedures, questionnaires, training, etc. and is responsible for monitoring compliance with departmental metrics, internal control activities, contractual obligations, regulatory requirements, and responding to customer inquiries / audits.

• Other duties as assigned or requested.

EDUCATION

Required

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

EXPERIENCE

Required

• 5 years in Audit and Compliance

• 3 years in Operational processing

Preferred

• None

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• Certified Public Accountant (CPA)

• Lean/ Six Sigma

SKILLS

• Demonstrate expert 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 assessments of vendors

• 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)

• Strong relationship building skills and ability to influence with and without authority in a matrixed organization

• Leadership qualities with an ability to motivate and inspire a group of individuals to achieve superior results

• High capacity to think analytically, interpret information / observations, apply judgment and make effective, strategic decisions

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Frequently

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

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 job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$68,400.00

Pay Range Maximum:

$105,900.00

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.

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For accommodation requests, please contact HR Services Online at [email protected]

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Req ID: J280109