Compliance Specialist - Sioux Falls, SD

Sanford Health•Sioux Falls, SD

2d•$28 - $44

About The Position

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We’re proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. The primary function of this position is to ensure compliance with the federal and state laws, regulations, and rules governing healthcare entities, and specifically, the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. Job Description Identifies risk areas, prepares audit tools, conducts audits, and provide analysis and recommendations to executive leadership. Conducts audits and provides support for other internal or external auditors; investigates and resolves compliance issues related to the healthcare environment. Evaluates regulatory agency reports and formulates responses and corrective actions. Maintains logs, indexes, files, computer databases, and other records pertaining to compliance and risk. Creates logs and systems for entering and tracking compliance guidelines. Confers with administrative staff regarding compliance risk areas and final reports. Develops strategies and leads compliance related committees/work groups. Implements compliance procedures. Responsible for ensuring compliance with governmental requirements. Demonstrates an advanced knowledge and skill in analyzing patient records to identify non-conformances in Current Procedural Terminology (CPT), International Classification of Diseases, Tenth Edition (ICD-10), and Healthcare Common Procedure Coding System (HCPCS) code assignment. Demonstrates both knowledge and application of Sanford Health Systems, policies, procedures, and guidelines.

Requirements

Bachelor’s degree in health related field or equivalent education is required.
Depending on department, may be required to maintain licensure/certification as appropriate to background, including but not limited to: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Medical Auditor (CPMA), Certified Coding Specialist-Physician-based (CCS-P), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Healthcare Constructor (CHC).
Complete continuing education requirements as necessary.

Nice To Haves

Master’s degree is preferred.
Prior relevant compliance work experience is preferred.
Certification in healthcare compliance is preferred but not mandatory.
Well qualified candidates will have strong skills in: • Project Management • Critical Thinking • Auditing / Evaluation / Investigation

Responsibilities

Identifies risk areas
Prepares audit tools
Conducts audits
Provides analysis and recommendations to executive leadership
Conducts audits and provides support for other internal or external auditors
Investigates and resolves compliance issues related to the healthcare environment
Evaluates regulatory agency reports and formulates responses and corrective actions
Maintains logs, indexes, files, computer databases, and other records pertaining to compliance and risk
Creates logs and systems for entering and tracking compliance guidelines
Confers with administrative staff regarding compliance risk areas and final reports
Develops strategies and leads compliance related committees/work groups
Implements compliance procedures
Responsible for ensuring compliance with governmental requirements
Demonstrates an advanced knowledge and skill in analyzing patient records to identify non-conformances in Current Procedural Terminology (CPT), International Classification of Diseases, Tenth Edition (ICD-10), and Healthcare Common Procedure Coding System (HCPCS) code assignment
Demonstrates both knowledge and application of Sanford Health Systems, policies, procedures, and guidelines