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:

• Conduct coding validation, documentation review, and data-driven analysis to ensure accurate risk capture and regulatory compliance
• Lead compliance reporting efforts by evaluating compliance data, audit information, and potential risks, and developing presentations for management
• Drive regulatory compliance by monitoring and interpreting regulatory changes, and overseeing the implementation of designated changes

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, operations, audit, finance, or regulatory development