California Licensed Compliance Consultant

Job Summary

To support compliance initiatives, the full-time California Licensed Compliance Consultant will apply advanced knowledge of medical coding and risk adjustment methodologies, supervise coding operations, and ensure compliance with national coding policies while working remotely.

Key responsibilities:

• Supervise and monitor coding operations, ensuring diagnoses are supported by provider documentation and valid medical records
• Conduct compliance activities and audits, developing strategies to adhere to regulations and documenting compliance efforts
• Lead compliance reporting and investigations, analyzing data and presenting findings to management and stakeholders

Required qualifications:

• Minimum six (6) years of medical coding experience
• Minimum three (3) years in a leadership role
• Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business, or related field, along with eight (8) years of relevant experience
• Certified Coding Specialist or equivalent certification from recognized organizations
• Proficiency with electronic medical records and coding applications