California Licensed Compliance Consultant

Job Summary

Supporting Health Plan Risk Adjustment operations, the full-time remote California Licensed Compliance Consultant will ensure government audit readiness, perform coding validation and documentation reviews, and collaborate with cross-functional teams to enhance coding quality and compliance.

Key responsibilities

• Conducts compliance activities and oversees business-specific projects to promote adherence to procedures and policies
• Leads compliance reporting efforts by evaluating compliance data and developing presentations for management
• Drives regulatory compliance by monitoring changes and implementing necessary adjustments in compliance standards and policies

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
• Minimum eight (8) years of experience in health care compliance, operations, audit, or related fields
• Certified Coding Specialist, Certified Risk Adjustment Coder, or Certified Professional Coder certification