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Sanford Health Compliance Specialist | Health Plan | Sioux Falls in Sioux Falls, South Dakota

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.

See yourself at Sanford!

Facility: Cherapa Place Building
Location: Sioux Falls, SD
Address: 300 N Cherapa Pl, Sioux Falls, SD 57103, USA
Shift: Day
Job Schedule: Full time
Weekly Hours: 40.00

Job Summary

The primary function of this position is to ensure compliance with the federal and state laws, regulations, and rules governing healthcare entities related to Sanford Health Plan's diverse plan offerings. 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.

Department Details

Well qualified candidates will have strong skills in project management, critical thinking and auditing/evaluation/investigation.

The day to day work of a compliance specialist is managing projects of varying scopes from start to end. Examples of Health Plan projects may include:

• Auditing / Investigations

• Managing External Reviews

• Process Improvement

• Training Design

• Process Mapping

• Policy / Regulation Research

• Member Utilization

• Risk Assessments

*Remote work is not an option.

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.

Benefits

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 talent@sanfordhealth.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-35393
Featured: No

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