Compliance Specialist

Sanford Health; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

Join a forward-thinking health system dedicated to compliance and quality in healthcare. As a Compliance Specialist, you'll manage projects that ensure adherence to federal and state regulations, particularly HIPAA. This role involves identifying risk areas, conducting audits, and developing compliance strategies to support the organization’s mission of health and healing. With a focus on continuous improvement, you will collaborate with various departments to enhance compliance policies and procedures. If you are passionate about making a difference in healthcare and possess strong analytical skills, this position offers a rewarding opportunity to contribute to a vital mission.

Qualifications

• Bachelor's degree in a health-related field or equivalent education is required.
• Prior relevant compliance work experience is preferred.

Responsibilities

• Ensure compliance with federal and state laws governing healthcare entities.
• Conduct audits and provide analysis and recommendations to executive leadership.

Skills

Project Management

Critical Thinking

Auditing / Evaluation / Investigation

Education

Bachelor's degree in health related field

Master's degree

Job description

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.

Work Shift:

8 Hours - Day Shifts (United States of America)

Scheduled Weekly Hours:

40 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.

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

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.

Job does require in office. Locations in:
• Sioux Falls, SD
• Bismarck, ND
• Fargo, ND
• Bemidji, MN
• Marshfield, WI

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 [e-mail].