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 documentation reviews, and partner with cross-functional teams to enhance coding quality and ensure regulatory compliance in a remote work environment.

Key responsibilities:

• Conducts coding validation and documentation reviews to ensure accurate risk capture and compliance with national coding policies
• Partners with operational, clinical, and compliance teams to identify risks and drive continuous improvement across Risk Adjustment programs
• Develops and presents audit result reports to regional staff and senior management, summarizing compliance data and potential risks

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 from the American Health Information Management Association or equivalent coding certification
• Experience in health care compliance, operations, audit, or related fields