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 coding validation, documentation review, and data-driven analysis to ensure accurate risk capture and regulatory compliance
• Develop compliance reports and assist in compliance investigations by analyzing data and identifying potential action steps
• Coordinate compliance efforts by assessing current compliance states, identifying gaps, and creating or revising compliance standards and training

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, along with six (6) years of experience in healthcare compliance or a directly related field
• Certified Risk Adjustment Coder, Certified Coding Specialist, or Certified Professional Coder