Sanford Health Compliance Specialist - Rehab Skilled & Senior Living in Sioux Falls, South Dakota
Job Title: Compliance Specialist | Rehab Skilled & Senior Living | Multi-City
Department : Compliance - HSD - Sioux Falls
Job Schedule: Full Time
Hours Per Shift: 8 hr
The primary function of this position is to ensure compliance with the federal and state laws, regulations, and rules governing healthcare entities. 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 concerns related to skilled coverage criteria and regulatory technical requirements. Demonstrates both knowledge and application of Sanford Health Systems and Good Samaritan Society policies, procedures, and guidelines.
Communicates effectively, verbally and 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, tools and develop systems to inform data trending to mitigate risk and watch trends. 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. Determine education that is necessary to meet compliance requirements, and create materials needed, provide training and support to the field. Recommend and implement changes and action plans to improve accuracy and meet regulations. Identify and apply references from CMS Publication 100, RAI Manual, MedPAC, OIG, and other Good Samaritan Society (GSS) policies and procedures to inform decisions and actions plans that are compliant with applicable regulations. Assist GSS SNFs with Medicare and Managed Care medical review and appeals with federal review contractors such as: OIG, UPIC, RAC, MAC, CERT, PERM, etc. to assure compliance and integrity with regulations.
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: RAC-CT through AANAC, Certified Professional Coder (CPC) or Certified Coding Specialist (CCS), or Registered Nurse (RN). 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 email@example.com .
Job Function: Legal and Compliance
Job Schedule: Full Time
Req Number: WD05512