California Licensed Compliance Consultant

Job Summary

To support compliance efforts, the full-time California Licensed Compliance Consultant will independently review medical records for accurate coding, serve as a subject matter expert on coding functions, and assist with compliance investigations, all while working remotely.

Key responsibilities:

• Independently review and assign ICD-10-CM diagnosis codes and hierarchical condition categories from medical records
• Conduct compliance investigations and document findings, providing recommendations for corrective actions
• Develop compliance reports and collaborate with stakeholders to ensure adherence to regulations and standards

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, finance, or related fields
• Certified Risk Adjustment Coder or equivalent coding certification
• Experience with risk adjustment coding platforms and electronic medical records