California Licensed Compliance Consultant
Job Summary
To support 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 for management and stakeholders
- Drive regulatory compliance by monitoring changes and implementing necessary compliance standards, policies, and procedures
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 from AHIMA or Certified Risk Adjustment Coder or Certified Professional Coder from AAPC
Complete Job Description
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