California Licensed Compliance Consultant

Job Summary

Supporting Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Consultant will oversee compliance oversight, conduct coding validation, and perform data-driven analysis to ensure regulatory compliance and coding integrity, working remotely from authorized states.

Key responsibilities

• Conducts compliance activities and develops strategic initiatives in partnership with internal and external stakeholders
• Leads compliance reporting efforts by evaluating compliance data and presenting findings to management
• Drives regulatory compliance by monitoring changes and implementing necessary adjustments to compliance standards and policies

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 related field, along with a minimum of eight (8) years of relevant experience
• Certified Coding Specialist, Certified Risk Adjustment Coder, or Certified Professional Coder certification