Lead Compliance Auditor | Compliance | Sioux Falls or Fargo
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.
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Facility: GSS National Campus
Location: Sioux Falls, SD
Address: 4800 W 57th St, Sioux Falls, SD 57108, USA
Job Schedule: Full time
Weekly Hours: 40.00
Leads the compliance coding audit function by providing day-to-day direction, mentorship and training.
Responsible for conducting internal audits and monitors to ensure that the organization’s processes and operations are in compliance with laws, corporate guidelines, best practices and contractual agreements. Serves as a subject matter expert in all forms of medical coding. Accountable to ensure and enhance current audit processes as well as ensure operational standardization, efficiency, accuracy, compliance and productivity.
Expert in general audit concepts and techniques, including the type of audits, the approaches and processes and the subsequent activities, as they relate to internal audits. Experience should also demonstrate expert level knowledge of Current Procedural Terminology (CPT)/International Statistical Classification of Diseases (ICD)-10, Healthcare Common Procedure Coding System (HCPCS), third party reimbursement guidelines and methodologies, highly effective management and teach-building skills, and demonstrated commitment to quality improvement. Possesses expert knowledge of auditing related to Medicare and third party payors. Meets independently with physicians to provide feedback, educate and train on appropriate documentation. Report findings of analyzed coding data to upper management and executives on any discrepancies or variances.
Interprets Federal rules and regulations. Researches regulation from various data sources. Possesses the ability in project control, management and planning techniques. Exhibits both knowledge and application of Sanford Health Systems, policies, procedures and guidelines. Demonstrates commitment to continuous learning for themselves and performs as a role model to other compliance audit staff.
Provides education to other auditors and coders regarding audit processes.
High school diploma or equivalent required. Advanced diploma or degree in health information management or healthcare related field is preferred.
Minimum of five years’ directly related coding experience is required.
Certification in one of the following is required: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC) or an equivalent. Certified Healthcare Auditor (CHA) certification to be completed within one year of employment is preferred.
Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, sick leave and paid time off. To review your benefit eligibility, visit https://sanfordhealth.jobs/benefits .
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 firstname.lastname@example.org .
Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
Job Function: Legal and Compliance
Req Number: R-37459