Laboratory Clinical Compliance Specialist - FT - Days

Sanford Health

2d•$31 - $50

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. Sanford Laboratories is a large integrated network of over 80 CLIA-certified laboratories. This enterprise network makes the expertise and testing capabilities of all 80 labs available to our client partners in 8 states. Sanford Laboratories is licensed as an independent reference laboratory within Sanford Health. The technical, management and support staff at Sanford Enterprise Laboratories is comprised of professionals with many years of hospital and reference laboratory experience. Included are phlebotomists, couriers, laboratory assistants, medical laboratory scientists, PhD scientists, medical laboratory technicians, client service representatives, consulting medical laboratory scientists, billing representatives, clerks, and information systems staff. Laboratory compliance is the backbone of our commitment to excellence. We are looking for a specialist to champion the standards that ensure high-quality care for every patient we serve. If you’re ready to lead at the intersection of quality and growth, we want to hear from you. The primary function of this position is to ensure compliance with the federal and state laws, regulations, and rules governing healthcare entities through use of their clinical perspective, expertise and critical thinking skills.

Requirements

Bachelor’s degree in health related field or equivalent education is required.
If degree is in nursing, graduate from a nationally accredited nursing program preferred, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA).
Minimum of three years’ experience working in a clinical role.
Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state.
Additional certification from specific professional societies as necessary for the role may be required within the first six months of employment from date of hire.
All certification and licensures must be maintained.
Obtains and subsequently maintains required department specific competencies and certifications.

Nice To Haves

Prior relevant compliance work experience is preferred.
Working knowledge specifically in Medicare and Medicaid reimbursement a plus.

Responsibilities

Possesses an understanding of the operations, system processes and procedures used in assigned service lines.
Identifies risk areas, prepares audit tools, conducts audits, and provides analysis, recommendations and education to staff and leadership, including executive leadership.
Demonstrates both understanding and application of Sanford Health and Good Samaritan Society systems, policies, procedures, and guidelines.
Responsible for evaluating, implementing and monitoring process and procedures that facilitate compliance with governmental and organizational requirements, including CLIA, CAP, COLA and JCAHO.
Identifies and validates correct CPT code billing for new lab test implementations, as well as ongoing updates or changes to the laboratory test compendium.
Registers Sanford Health-specific testing for DEX/MolDX coding.
Successfully able to properly and accurately complete clinical assessment tools and compliance related documents, as applicable to the area of assignment.
Analyze and report on data and work with assigned locations and interdisciplinary teams to ensure accuracy of data submission for payment.
Collaborates with operational teams to perform reviews and analyze processes.
Confers with administrative staff regarding compliance risk areas and creates reports summarizing information.
Identifies needed targeted compliance education.
Plans education and training content and identifies appropriate audiences for material.
Plans for training roll-out and documents progress and completion.
Provides training to clinical staff, including providers as needed.
Conducts audits of clinical, financial, laboratory, or other records and provides support for other internal or external auditors; investigates and resolves compliance issues related to assigned service lines.
Evaluates regulatory agency reports and formulates responses and corrective actions.
Creates summary reports and maintains records to support responses.
Participates in enterprise risk assessment activities and leads focused risk assessments in assigned service lines.
Demonstrates an advanced knowledge and skill in analyzing patient and resident/client records to identify non-compliance in Current Procedural Terminology (CPT), International Classification of Diseases, Tenth Edition (ICD-10), and Healthcare Common Procedure Coding System (HCPCS) or other code assignment as applicable.
Able to assign ICD-10 codes and abstract diagnosis and treatment information from records.
Provide support to assigned service lines to ensure care provided is being properly documented and coded, ensuring alignment with laboratory medical necessity guidelines.
Creates logs and systems for entering and tracking compliance guidelines.
Develops strategies and leads compliance related committees/work groups.
Employee may be required to travel within the enterprise occasionally to support training and strategy advancement.