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
- Develop compliance reports by evaluating compliance data, audit information, and potential risks, reporting findings to management
- Collaborate with operational, clinical, and compliance teams to identify risks, improve coding quality, and support audit activities
Required qualifications
- Minimum four (4) years of medical coding experience
- Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business, or related field, and a minimum of six (6) years in health care compliance or related fields
- Certified Risk Adjustment Coder, Certified Coding Specialist, or Certified Professional Coder
Complete Job Description
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