Job Information

Sanford Health Clinical Compliance Specialist - Compliance 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.

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Facility: GSS National Campus
Location: Sioux Falls, SD
Address: 4800 W 57th St, Sioux Falls, SD 57108, 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, and specifically, the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule from a clinical perspective and clinical expertise. 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. Analyze clinical data to plan training as appropriate. Research and understand payment methodology in order to provide training to appropriate staff.

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 and resident/client 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. Accurately assigns ICD-10 codes and abstraction of diagnosis and treatment. Provide support to designated facilities and regions ensuring care provided is being properly coded.

Successfully able to properly and accurately complete minimum data set (MDS) assessments. Analyze Medicaid data specifically, and work with designated facilities interdisciplinary team to ensure accurate reimbursement.

Demonstrates both knowledge and application of Sanford Health and Good Samaritan Society systems, policies, procedures, and guidelines.

Qualifications

Performs Clinical Assessment and Review related to nursing practice.

  • Care Plans

  • Infection Control Practices

  • Abuse, Neglect, Exploitation documentation and reporting

  • Medication Administration

Conducts monitoring of locations with serious survey findings.

  • To assure POC’s are implemented, accepted and sustained.

Completes audits and leads training specific to nursing documentation.

  • To support medical necessity, coverage and billing requirement.

50-75% Travel. Driving personal car to and from Sanford Health facilities. May also drive rental cars or use air transportation for travel.

Bachelor’s degree in health related field or equivalent education is required.

If degree is in nursing, graduate from a nationally accredited nursing program preferred, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA).

Minimum of three years’ experience working in a clinical role, preferably with minimum data set (MDS) coordinating experience. Prior relevant compliance work experience is preferred. Working knowledge specifically in Medicare and Medicaid reimbursement a plus.

Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state.

Additional certification from the American Association of Nurse Assessment Coordination (AANAC) may be required within the first six months of employment from date of hire.

All certification and licensures must be maintained.

Obtains and subsequently maintains required department specific competencies and certifications.

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-51927
Featured: No