California Licensed Compliance Consultant

Job Summary

To support Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Consultant will oversee compliance activities, conduct coding validation, and partner with cross-functional teams to ensure regulatory compliance and improve coding quality in a remote work environment.

Key responsibilities:

• Conducts compliance activities and oversees business-specific projects to ensure adherence to regulations and standards
• Leads compliance reporting efforts by evaluating data, summarizing audit information, and developing presentations for management
• Drives regulatory compliance by monitoring changes and implementing necessary adjustments to compliance standards and procedures

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 certification from recognized organizations
• Experience in health care compliance, audit, or regulatory policy development