California Licensed Compliance Consultant

Job Summary

Supporting Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Consultant will manage compliance oversight, coding validation, and quality assurance reviews while working remotely from an authorized state.

Key responsibilities:

• Oversee compliance activities by collaborating with internal and external stakeholders to ensure adherence to regulations and standards
• Conduct coding validation and documentation reviews to ensure accurate risk capture and regulatory compliance
• Lead compliance reporting efforts by evaluating data and presenting findings to management and key stakeholders

Required qualifications:

• Minimum six (6) years of medical coding experience
• Minimum three (3) years of experience in a leadership role
• Bachelor's degree in a relevant field or equivalent work experience
• Certified Coding Specialist or equivalent coding certification
• Experience in health care compliance, operations, or related fields