California Licensed Compliance Consultant

Job Summary

To support 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 to ensure accurate risk capture and coding integrity.

Key responsibilities:

• Conduct compliance activities and oversee business-specific projects to promote adherence to regulations and improve operational processes
• Lead compliance reporting efforts by evaluating compliance data and developing presentations for management and stakeholders
• Drive regulatory compliance by monitoring changes and implementing necessary adjustments to compliance standards and policies

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, Certified Risk Adjustment Coder, or Certified Professional Coder certification