NewSenior Director Coding Sanford HealthSenior Director CodingSioux Falls, South Dakota$67–$110.50 / hourCollaborates and coordinates with various Sanford Health leaders to ensure coding integrity and accurate data collection is achieved to support a seamless continuum of care, supporting provider compensation models, compliant processes, optimal reimbursement and efficient revenue cycle functions. Responsible for operational budget and strategic initiatives and formulation of Sanford Health's coding operating model and enhancement of coding related services throughout the system in order to drive and meet the goals of revenue services.
Configuration And Coding Analyst Avera HealthConfiguration And Coding AnalystSioux Falls, SD$63,960–$96,200 / yearResearch, evaluate, and implement quarterly and ongoing updates to medical coding, reimbursement methodologies, regulatory requirements, and health plan policies to ensure system configurations remain current and compliant with CMS, Medicare, Medicaid, ACA, HIPAA, NCQA, and commercial payer requirements. The position is responsible for validating claims processing and logic, maintaining coding integrity, troubleshooting configuration issues, and supporting continuous system optimization to improve automation, regulatory compliance, operational efficiency, accurate claims payment and provider coding reconsiderations.
Configuration and Coding Analyst Avera HealthConfiguration and Coding AnalystSioux Falls, SD$63,960–$96,200 / yearResearch, evaluate, and implement quarterly and ongoing updates to medical coding, reimbursement methodologies, regulatory requirements, and health plan policies to ensure system configurations remain current and compliant with CMS, Medicare, Medicaid, ACA, HIPAA, NCQA, and commercial payer requirements. The position is responsible for validating claims processing and logic, maintaining coding integrity, troubleshooting configuration issues, and supporting continuous system optimization to improve automation, regulatory compliance, operational efficiency, accurate claims payment and provider coding reconsiderations.
Configuration and Coding Analyst AveraConfiguration and Coding AnalystSioux Falls, South DakotaResearch, evaluate, and implement quarterly and ongoing updates to medical coding, reimbursement methodologies, regulatory requirements, and health plan policies to ensure system configurations remain current and compliant with CMS, Medicare, Medicaid, ACA, HIPAA, NCQA, and commercial payer requirements. The position is responsible for validating claims processing and logic, maintaining coding integrity, troubleshooting configuration issues, and supporting continuous system optimization to improve automation, regulatory compliance, operational efficiency, accurate claims payment and provider coding reconsiderations.
Certified Professional Coder, Special Investigations Unit (Aetna SIU) CVS Health CorpCertified Professional Coder, Special Investigations Unit (Aetna SIU)SD$43,888–$93,574 / yearThe Certified Professional Coder (CPC) will perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. Uses department resources regularly and follows workflows with minimal assistance or intervention to perform daily work to meet metrics.
NewClaim Benefit Specialist CVS Health CorpClaim Benefit SpecialistSD$17–$28.46 / hourAnalyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department. Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing.
Coder II - Inpatient AveraCoder II - InpatientSioux Falls, South DakotaIP Coder II is distinguished by specific services lines which could include but not limited to the following: Surgery, NICU/PICU, Cardiovascular, Women’s Health, OB, Nursery, Behavioral Health, Orthopedics, Inpatient Rehabilitation and others as appropriate. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds.
Coder II - Inpatient Avera HealthCoder II - InpatientSioux Falls, SD$25.50–$38 / hourIP Coder II is distinguished by specific services lines which could include but not limited to the following: Surgery, NICU/PICU, Cardiovascular, Women's Health, OB, Nursery, Behavioral Health, Orthopedics, Inpatient Rehabilitation and others as appropriate. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds.
Revenue Integrity Analyst AveraRevenue Integrity AnalystSioux Falls, South Dakota$25.50–$38.25 / hourRequired Education, License/Certification, or Work Experience: Associate's in Healthcare Administration, Finance, Business Analytics, or related field and/or 2-3 years of experience in healthcare revenue cycle analytics, charge auditing, or payment integrity. The analyst collaborates with clinical, billing, coding, IT, and payer relations teams to identify trends, resolve discrepancies, and drive continuous improvement across Hospital Billing (HB) and Professional Billing (PB) services.
Senior Secretary (JPA) South Dakota State GovernmentSenior Secretary (JPA)Sioux Falls, SD$19.27–$25 / hourSelected individuals must possess the physical ability to successfully complete the practical self-defense exam, which involves the following: Lift arms above head and kick as high as own waist; Stabilize another person to accomplish a controlled take down; Use arms, palms of hands, shins, and feet to deliver blows; Withstand impact (slow speed or with a safety bag) on own body from strikes/blows; Rotate body 90 degrees with feet planted for striking with foot or using a defensive tactic; Get down on one or both knees and up again with multiple repetitions; Additionally, TB (tuberculosis) screening is required of all new employees upon hire. Excellent interpersonal, multi-tasking and administrative skills; Ability to read and comprehend the English language; Ability to effectively communicate fluently in English both verbally and in writing; Individual must be thorough, detail oriented and have the ability to work independently; Individual must be proficient in HIPAA compliance; Proficient in Microsoft Word and Excel; Basic knowledge of medical terminology; and.
NewSupervisor, Utilization Management TriWest Healthcare AllianceSupervisor, Utilization ManagementSioux Falls, SDRemoteFull timeTechnical Skills: Thorough knowledge of policies and procedures, knowledge of managed care principles and methods; medical terminology; proficiency in the application of clinical criteria: InterQual, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders, current Procedural Terminology, and Healthcare Common Procedural Coding System, and American Dental codes; working knowledge with medical management systems; proficient with Microsoft Office; knowledge of UM Process; reporting techniques. • Prepares work schedules and monitors staff caseloads to ensure adequate staffing levels at all times and accurate data entry and application of the medical management system.
Revenue Integrity Analyst Avera HealthRevenue Integrity AnalystSioux Falls, SD$25.50–$38.25 / hourRequired Education, License/Certification, or Work Experience: Associate's in Healthcare Administration, Finance, Business Analytics, or related field and/or 2-3 years of experience in healthcare revenue cycle analytics, charge auditing, or payment integrity. The analyst collaborates with clinical, billing, coding, IT, and payer relations teams to identify trends, resolve discrepancies, and drive continuous improvement across Hospital Billing (HB) and Professional Billing (PB) services.
Certified Medical Assistant (CMA) – Regional Drug Dependency Unit Akicita FederalCertified Medical Assistant (CMA) – Regional Drug Dependency UnitSioux Falls, South DakotaThis role is responsible for assisting with patient care activities, performing routine clinical tasks, managing patient records, and supporting the overall operation of the unit, ensuring compassionate, culturally sensitive care for individuals undergoing substance abuse treatment. $50,000 - $65,000 a year Position Summary The Certified Medical Assistant (CMA) will provide clinical and administrative support to the healthcare team in the Regional Drug Dependency Unit (RDDU) at the Great Plains Area facility in Winnebago, NE.
Senior Investigator, Special Investigations Unit (Aetna SIU) CVS Health CorpSenior Investigator, Special Investigations Unit (Aetna SIU)SD$46,988–$112,200 / yearThis position will routinely handle high profile or highly sensitive matters involving cases that are national in scope, as well as, complex cases involving multi-lines of business, multiple subjects, or intricate healthcare fraud schemes. Strong communication skills, both written and oral, are necessary for the development and implementation of professional presentations for internal and external stakeholders regarding healthcare fraud matters and Enterprise approach to FWA.
Clinical Quality Specialist - Canton Medical Center - Full Time Sanford HealthClinical Quality Specialist - Canton Medical Center - Full TimeCanton, South Dakota$24–$38.50 / hourGraduate 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). 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.
Senior Risk Adjustment Auditor - Health Plan Sanford HealthSenior Risk Adjustment Auditor - Health PlanSDRemote$31–$49.50 / hourProvides overall educational support and coding quality assurance activities to both internal and external stakeholders as it relates to Medicare Advantage, ACA/Exchange and Medicaid risk adjustment reimbursement methodologies and policies to ensure the accuracy and integrity of risk adjustment data submitted to the Centers for Medicare & Medicaid Services (CMS) and the Department of Health Services (DHS). Applies expertise in HCC documentation, audit rules,, risk adjustment operations, and general clinical knowledge to increase the accuracy and completeness of our initiatives, including Risk Adjustment Data Validation (RADV) audits, retrospective and prospective audits, vendor quality assurance reviews, and provider and clinical staff education.
Configuration Analyst AveraConfiguration AnalystSioux Falls, South Dakota$63,960–$96,200 / yearRequirement Analysis: Uses experience and judgement to plan and accomplish goals; performs a variety of complicated tasks to ensure that the core claims system is configured correctly by reviewing the system components and validating that the configuration aligns to legal plan documents and regulatory requirements. A Brief Overview The Avera Health Plan Configuration Analyst is responsible for the design, implementation, and support of the Epic Tapestry module, which manages health plan administration, benefits, fee schedules, claims, enrollment, care coordination, clinical/authorizations and provider data.
Medicare Programs Clinical Lead - SD, ND, NE Sanford HealthMedicare Programs Clinical Lead - SD, ND, NESioux Falls, SD$31–$49.50 / hourGraduate 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). Leads clinical operations of Medicare programs with a primary focus in model of care development and delivery, healthcare effectiveness data and information set (HEDIS), Medicare star rating, Chronic Care Improvement (CCIP) and risk adjustment.
Utilization Clinical Reviewer TriWest Healthcare AllianceUtilization Clinical ReviewerSioux Falls, SDRemoteFull timeApplies clinical knowledge to make determinations for preauthorization, inpatient and continued stay reviews for Behavioral Health and Medical/Surgical requests to establish medical necessity, benefit coverage, appropriateness of quality of care, and length of stay or care plan. The Utilization Management Clinical Review nurse reviews and makes decisions about the appropriateness and level of beneficiary care being provided in an effort to provide cost effective care and ensure proper utilization of resources.
Case Manager (LCSW) TriWest Healthcare AllianceCase Manager (LCSW)Sioux Falls, SDRemoteFull timeFunctions as an advocate for the beneficiary by ensuring access to necessary care and maintaining Beneficiary's safety, locating specialized services outside the network by identifying providers, exploring nature of services offered, and facilitating process. Independent Thinking / Self-Initiative: Resourceful critical thinker who is able to prioritize tasks essential to achieving desires outcomes, demonstration a proactive commitment to task completion and the ability to identify and secure necessary resources.