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.

Key responsibilities:

• Conduct coding validation, documentation review, and data-driven analysis to ensure accurate risk capture and regulatory compliance
• Lead compliance reporting efforts by evaluating compliance data and developing presentations to convey key findings to management
• Drive regulatory compliance by monitoring complex regulatory changes and overseeing the implementation of designated changes

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 with at least eight (8) years of experience in healthcare compliance or related areas
• Certified Coding Specialist from the American Health Information Management Association or equivalent coding certification