California Licensed Compliance Consultant

Job Summary

To support 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 performing coding validation and data-driven analysis in a remote environment.

Key responsibilities

• Conduct compliance investigations and audits, ensuring adherence to coding policies and regulatory standards
• Develop and present compliance reports summarizing audit findings, risks, and recommendations to management
• Collaborate with cross-functional teams to identify risks, improve coding quality, and support continuous improvement initiatives

Required qualifications

• Minimum four (4) years of medical coding experience
• Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business, or related field, plus six (6) years of experience in health care compliance or related areas
• Certified Risk Adjustment Coder, Certified Coding Specialist, or Certified Professional Coder certification