California Licensed Compliance Consultant

Job Summary

To support Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Consultant will oversee government audit readiness, compliance oversight, and internal quality assurance reviews while working remotely and collaborating with operational, clinical, and compliance teams to enhance coding quality and regulatory compliance.

Key responsibilities:

• Conduct coding validation, documentation review, and data-driven analysis to ensure accurate risk capture and compliance
• Lead compliance reporting efforts by evaluating compliance data and developing presentations to convey findings to management
• Manage compliance investigations and coordinate the collection and analysis of data to recommend corrective action plans

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 or equivalent certification from recognized professional organizations