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 ensure regulatory adherence and improve coding quality in a remote work environment.

Key responsibilities

• Conducts compliance activities and oversees coding validation to ensure accuracy and regulatory compliance
• Leads compliance reporting efforts by summarizing audit data and presenting findings to management
• Manages projects related to compliance initiatives, identifying gaps and implementing corrective actions

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
• Certified Coding Specialist, Certified Risk Adjustment Coder, or Certified Professional Coder certification
• Minimum eight (8) years of experience in health care compliance, operations, audit, or related fields