California Licensed Compliance Consultant

Job Summary

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

Key responsibilities

• Conducts compliance activities by partnering with stakeholders and applying regulations to design and execute strategic compliance initiatives
• Leads compliance reporting efforts by evaluating compliance data and developing presentations to convey findings to management
• Drives regulatory compliance by monitoring regulatory changes and overseeing the implementation of necessary adjustments

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 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