Compliance Specialist

Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America's heartland.

Work Shift:
8 Hours - Day Shifts (United States of America)
Scheduled Weekly Hours:
40
Compensation:
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
Bachelor's degree in health related field or equivalent education is required. Master's 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.

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