California Licensed Compliance Consultant

Job Summary

To ensure compliance with national coding policies and standards, the full-time California Licensed Compliance Consultant will apply advanced knowledge of medical coding and risk adjustment methodologies while supervising coding operations and conducting audits remotely.

Key responsibilities:

• Supervise and monitor coding operations, ensuring diagnoses are supported by proper documentation and valid medical records
• Analyze operational data to identify trends, inconsistencies, and workflow barriers, implementing corrective actions as needed
• Lead compliance reporting and investigations, summarizing data and presenting findings to management and stakeholders

Required qualifications:

• Minimum six (6) years of medical coding experience
• Minimum three (3) years in a leadership role, with or without direct reports
• 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, Certified Risk Adjustment Coder, or Certified Professional Coder certification