California Licensed Compliance Consultant

Job Summary

To ensure compliance with national coding policies, the full-time remote California Licensed Compliance Consultant will supervise medical coding operations, review complex coding scenarios, and analyze operational data to implement corrective actions related to risk adjustment and clinical documentation standards.

Key responsibilities

• Supervise and monitor coding operations to ensure diagnoses are supported by appropriate documentation and coding standards
• Conduct compliance activities and lead investigations by analyzing data and coordinating with stakeholders to address compliance issues
• Develop and present audit reports to management, summarizing compliance data and identifying key performance indicators

Required qualifications

• Minimum six (6) years of medical coding experience
• Minimum three (3) years 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 or equivalent coding certification
• Proficiency with electronic medical records and coding applications