California Licensed Compliance Consultant

Job Summary

Supporting Health Plan Risk Adjustment operations, the full-time remote California Licensed Compliance Consultant will manage government audit readiness, compliance oversight, and internal quality assurance reviews while performing coding validation and data-driven analysis to ensure accurate risk capture and regulatory compliance.

Key responsibilities

• Conduct compliance investigations and audits, analyzing data and providing recommendations for corrective actions
• Develop compliance reports by summarizing compliance data and reporting key findings to management
• Collaborate with cross-functional teams to implement compliance initiatives and monitor adherence to regulations

Required qualifications

• Minimum four (4) years of medical coding experience
• Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business, or a related field
• Minimum six (6) years of experience in health care compliance, operations, audit, or a related field
• Certified Risk Adjustment Coder, Certified Coding Specialist, or Certified Professional Coder
• Experience in conducting coding audits and ensuring regulatory compliance