California Licensed Compliance Consultant

Job Summary

Supporting Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Consultant will manage government audit readiness, compliance oversight, and internal quality assurance reviews, while working remotely to ensure accurate risk capture and coding integrity.

Key Responsibilities

• Conducts coding validation, documentation review, and data-driven analysis to ensure regulatory compliance and coding integrity
• Partners with operational, clinical, and compliance teams to identify risks and improve coding quality across Risk Adjustment programs
• Develops and presents audit result reports to regional staff and senior management, driving continuous improvement initiatives

Required Qualifications

• Minimum six (6) years of medical coding experience
• Minimum three (3) years of experience in a leadership role
• Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business, or a related field, along with a minimum of eight (8) years of relevant experience
• Certified Coding Specialist from the American Health Information Management Association OR Certified Risk Adjustment Coder OR Certified Professional Coder from the American Academy of Professional Coders
• Experience in health care compliance, operations, audit, finance, or regulatory development