California Licensed Compliance Consultant

Job Summary

To support Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Consultant will manage compliance oversight, conduct coding validation, and perform data-driven analysis to ensure accurate risk capture and regulatory compliance while working remotely.

Key responsibilities

• Conducts compliance activities by partnering with stakeholders and applying regulations to design and execute compliance initiatives
• Leads compliance reporting efforts by evaluating compliance data and developing presentations to convey findings to management
• Drives regulatory compliance by monitoring changes and overseeing the implementation of designated compliance efforts

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 with a minimum of eight (8) years of relevant experience
• Certified Coding Specialist or equivalent coding certification from recognized associations