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:

• Oversee compliance activities and develop strategic initiatives in partnership with internal and external stakeholders
• Conduct coding validation and documentation reviews to ensure coding integrity and adherence to regulations
• Lead compliance reporting efforts by evaluating compliance data and presenting key findings to management

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
• Minimum eight (8) years of experience in health care compliance, operations, audit, or a directly related field
• Certified Coding Specialist or equivalent coding certification from recognized organizations