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 performing coding validation and data-driven analysis, all in a remote work environment.

Key responsibilities

• Conducts compliance activities by applying regulations and standards, designing strategic compliance initiatives, and documenting compliance efforts
• Leads compliance reporting by evaluating compliance data, summarizing audit information, and developing presentations for management
• Drives regulatory compliance by monitoring changes, assessing current compliance states, and implementing necessary corrective actions

Required qualifications

• Minimum six (6) years of medical coding experience
• Minimum three (3) years in a leadership role
• Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business, or related field with a minimum of eight (8) years in health care compliance or related fields
• Certified Coding Specialist or equivalent coding certification
• Experience in health care operations, audit, finance, or regulatory compliance