RN Clinical Compliance Specialist - Post Acute Care

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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Department Details

Summary

Job Description

Possesses an understanding of the operations, system processes and procedures used in assigned service lines. Identifies risk areas, prepares audit tools, conducts audits, and provide analysis, recommendations and education to staff and leadership, including executive leadership.

Demonstrates both understanding and application of Sanford Health and Good Samaritan Society systems, policies, procedures, and guidelines. Responsible for evaluating, implementing and monitoring process and procedures that faciliate compliance with governmental and organizational requirements.

Successfully able to properly and accurately complete clinical assessment tools and compliance related documents, as applicable to the area of assignment. Analyze and report on data, and work with assigned locations and interdisciplinary teams to ensure accuracy of data submission for payment and to meet other requirements.

Collaborates with operational teams to perform reviews and analyze processes. Confers with administrative staff regarding compliance risk areas and creates reports summarizing information.

Identifies needed targeted compliance education. Plans education and training content and identifies appropriate audiences for material. Plans for training roll-out and documents progress and completion. Provides training to clinical staff, including provides as needed.

Conducts audits of clinical, financial or other records and provides support for other internal or external auditors; investigates and resolves compliance issues related to assigned service lines. Evaluates regulatory agency reports and formulates responses and corrective actions. Creates summary reports and maintains records to support responses.

Participates in enterprise risk assessment activities and leads focused risk assessments in assigned service lines.

Demonstrates an advanced knowledge and skill in analyzing patient and resident/client records to identify non-compliance in Current Procedural Terminology (CPT), International Classification of Diseases, Tenth Edition (ICD-10), and Healthcare Common Procedure Coding System (HCPCS) or other code assignment as applicable. Able to assigns ICD-10 codes and abstract diagnosis and treatment information from records. Provide support to assigned service lines to ensure care provided is being properly documented and coded.

Creates logs and systems for entering and tracking compliance guidelines.

Develops strategies and leads compliance related committees/work groups.

Qualifications

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. Skilled Nursing clinical experience preferred. 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 specific professional societies as necessary for the role 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.

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.