California Licensed Compliance Consultant

Job Summary

Supporting Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Consultant will manage compliance oversight, conduct coding validation, and partner with cross-functional teams to ensure regulatory compliance and quality improvement, working remotely from authorized states.

Key responsibilities:

• Conducts compliance activities and oversees business-specific projects to promote adherence to regulations and improve operational processes
• Leads compliance reporting efforts by evaluating compliance data and developing presentations to convey findings to management
• Drives regulatory compliance by monitoring changes and implementing necessary adjustments to 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, along with eight (8) years of relevant experience
• Certified Coding Specialist or equivalent coding certification from recognized associations
• Experience in health care compliance, operations, audit, or related fields