California Licensed Compliance Consultant

Job Summary

To support Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Consultant will ensure government audit readiness, conduct coding validation, and collaborate with cross-functional teams to enhance compliance and coding integrity in a remote work environment.

Key responsibilities:

• Oversee compliance activities by partnering with stakeholders and applying regulations to develop strategic compliance initiatives
• Lead compliance reporting efforts by summarizing compliance data and presenting key findings to management and stakeholders
• Manage compliance investigations and projects, coordinating data collection, analysis, and corrective action recommendations

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 related field, along with eight (8) years of relevant experience
• Certified Coding Specialist or equivalent coding certification from recognized organizations