Compliance Specialist

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. Were proud to offer many development and advancement opportunities to our nearly 50000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

Work Shift:

8 Hours - Day Shifts (United States of America)

Scheduled Weekly Hours:

40

Salary Range: $27.50 - $44.00

Union Position:

No

Department Details

Well qualified candidates will have strong skills in:
Project Management
Critical Thinking
Auditing / Evaluation / Investigation

The day to day work of a compliance specialist is managing projects of varying scopes from start to end.
Key accountabilities of Health Plan Compliance Department include:
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

Summary

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.

Qualifications

Bachelors degree in health related field or equivalent education is required. Masters degree is preferred.

Prior relevant compliance work experience is preferred.

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. Certification in healthcare compliance is preferred but not mandatory.

Sanford is an EEO/AA Employer M/F/Disability/Vet.

If you are an individual with a disability and would like to request an accommodation for help with your online application please call 1- or send an email to