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 and collaborating with operational, clinical, and compliance teams to enhance coding quality and regulatory compliance.

Key responsibilities

• Conducting compliance activities and developing strategic initiatives to ensure adherence to regulations and standards
• Leading compliance reporting efforts by summarizing compliance data and presenting key findings to management
• Managing projects related to compliance components and overseeing the implementation of regulatory 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, along with eight (8) years of relevant experience
• Certified Coding Specialist, Certified Risk Adjustment Coder, or Certified Professional Coder certification
• Experience in health care compliance, operations, audit, finance, or regulatory policy development