California Licensed Compliance Consultant

Job Summary

Supporting Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Consultant will oversee compliance activities, conduct coding validation, and partner with various teams to enhance coding quality and ensure regulatory compliance in a remote setting.

Key responsibilities:

• Conduct compliance investigations and audits, analyzing data to identify risks and recommend corrective actions
• Lead compliance reporting efforts by evaluating compliance data and presenting findings to management and stakeholders
• Manage projects related to compliance initiatives, ensuring adherence to regulations and developing strategic plans for improvement

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 a minimum of eight (8) years of relevant experience
• Certified Coding Specialist or equivalent certification from recognized professional organizations