Compliance Specialist - Compliance - HSD

Job Title: Compliance Specialist | Compliance - HSD | Multi-City

City: Multi-City

State: Multi-State

Department : Compliance - HSD - Bismarck

Job Schedule: Full Time

Shift: Days

Hours Per Shift: 8 hr

JOB 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.
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.

POSITION RESPONSIBILITIES

Communicating effectively in writing
as appropriate for the needs of the audience. Analyzes complex reports as
revealed by the data. Facilitates compliance-related business process
implementation or improvement initiatives. Ensures compliance with current government
and industry audit practices and requirements. Documents established audit
processes, practices and procedures. Designs, develops and implements compliance
testing criteria and tools. Works with a variety of audit methods, tools and
techniques. Chooses audit methods, instruments and plans according to the
nature of assessment target. Formulates corrective action plans to remedy
training or knowledge gaps in an organization. Provides accurate and timely
ICD-10 coding and abstracting of diagnoses and treatments. Identifies key
medical information coding concepts and features such as Current Procedural
Terminology (CPT) and International Classification of Diseases (ICD). Implements
internal and external audit requirements for a specific business activity.

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.
Maintain licensure/certification as appropriate to background, including but not limited to: Certified Professional Coder (CPC) or Certified Coding Specialist (CCS). Complete continuing education requirements as necessary. Certification in healthcare compliance is preferred but not mandatory.

About Sanford Health:

At Sanford Health, we are dedicated to the work of health and healing.
Every day, we show that commitment by delivering the highest quality of care to the communities we serve.
We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care, leading-edge technologies and world-class facilities.
In addition to strong clinical care, we are also committed to research, education and community growth.
We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases.
We continuously seek new ways to achieve our vision of improving the human condition here in your community, across the region and around the world.
The entire team at Sanford Health recognizes the value of healthy families and communities.
We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future.
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 1-877-673-0854 or send an email to talent@sanfordhealth.org .

City: Multi-City

State: Multi-State

Job Function: Legal and Compliance

Job Schedule: Full Time

Shift: Days

Req Number: WD15133