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 compliance investigations and audits to ensure adherence to coding standards and regulations
• Develop compliance reports by evaluating data and summarizing audit findings for management
• Collaborate with cross-functional teams to identify risks and implement improvements in coding quality

Required qualifications

• Minimum four (4) years of medical coding experience
• Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business, or a related field
• Minimum six (6) years of experience in health care compliance, operations, audit, or a directly related field
• Certified Risk Adjustment Coder, Certified Coding Specialist, or Certified Professional Coder
• Experience in conducting compliance activities and developing compliance standards and policies