Compliance Specialist

Sanford Health•Sioux Falls, ND

12d•$28 - $44•Onsite

About The Position

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. 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.
Prior relevant compliance work experience is preferred.
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.
Certification in healthcare compliance is preferred but not mandatory.

Responsibilities

Compliance Policies and Procedures
Compliance Training & Education
Reported Concerns
Effective Lines of Communication
Risk Assessment & Work Plans
Compliance Monitoring & Auditing
Mental Health Parity Oversight
External Audit Management
Vendor Oversight
Sales & Marketing Compliance
Policy / Regulation Research
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.