California Licensed Compliance Consultant

Job Summary

Supporting Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Consultant will manage government audit readiness, compliance oversight, and internal quality assurance reviews while working remotely.

Key responsibilities:

• Conducts coding validation, documentation review, and data-driven analysis to ensure accurate risk capture and regulatory compliance
• Partners with operational, clinical, and compliance teams to identify risks and improve coding quality while supporting audit activities
• Leads compliance reporting efforts by evaluating compliance data and developing presentations to convey key findings to management

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 a directly related field
• Certified Coding Specialist OR Certified Risk Adjustment Coder OR Certified Professional Coder