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Job Title: Clinical Compliance Specialist | Legal & Compliance | Multi-CityCity: Multi-CityState: Multi-StateDepartment : Compliance - HSD - Sioux FallsJob Schedule: Full TimeShift: DaysHours Per Shift: 8 hrJOB SUMMARYThe 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.POSITION RESPONSIBILITIESProvides accurate and timely ICD-10 coding and abstracting of diagnoses and treatments. Implements internal and external audit requirements for a specific business activity. Communicating effectively 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 and tools. 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.QUALIFICATIONSBachelor's degree in health related field or equivalent education is required.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.Minimum of three years of experience working in a clinical role, with OASIS and/or minimum data set (MDS) coordinating experience preferred. Prior relevant compliance work experience and knowledge specifically in Medicare and Medicaid reimbursement a plus.Additional certification as a Certified Oasis Quality Specialist (COQS) and/or a 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.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 protected] .City: Multi-CityState: Multi-StateJob Function: Legal and ComplianceJob Schedule: Full TimeShift: DaysReq Number: WD13867
Vacancy caducado!