California Licensed Compliance Consultant
Job Summary
To support Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Consultant will manage compliance oversight, coding validation, and internal quality assurance reviews while working remotely.
Key responsibilities:
- Conduct compliance investigations and audits to ensure adherence to coding standards and regulations
- Develop compliance reports and presentations summarizing audit findings and potential risks
- Collaborate with cross-functional teams to identify risks and improve coding quality across Risk Adjustment programs
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, with a minimum of six (6) years in health care compliance or related areas
- Certified Risk Adjustment Coder, Certified Coding Specialist, or Certified Professional Coder
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