California Licensed Compliance Consultant

Job Summary

To support the Risk Adjustment Coding Compliance team, the full-time remote California Licensed Compliance Consultant will manage complex targeted reviews and external audits, develop project workplans, monitor quality assurance, and serve as a subject matter expert in compliance and coding policies.

Key responsibilities

• Oversee business-specific projects by developing work plans, coordinating resources, and ensuring adherence to compliance standards
• Lead compliance reporting efforts by summarizing data, identifying risks, and presenting findings to management and stakeholders
• Conduct compliance investigations by analyzing data, leading interviews, and recommending corrective actions for identified issues

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
• Experience in health care compliance, operations, audit, finance, or regulatory development