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 from an authorized state.

Key responsibilities

• Conducts compliance activities by partnering with stakeholders and applying established regulations to ensure adherence to compliance efforts
• Leads compliance reporting efforts by evaluating compliance data and summarizing key findings for management and stakeholders
• Drives regulatory compliance by monitoring and interpreting complex regulatory changes and overseeing the implementation of designated 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 from the American Health Information Management Association or equivalent coding certification