The Compliance Consultant will serve as a subject matter expert in medical coding, responsible for reviewing medical records, performing audits, and conducting risk assessments and adjustments. They will ensure compliance with national coding policies and procedures and assist with auditing assigned lines of business for coding accuracy. Additionally, this position involves assisting in the development of audit result reports and supporting compliance with the Principles of Responsibility.

This individual contributor is primarily responsible for conducting company compliance activities under the guidance of more senior employees. Responsibilities include assisting with compliance reporting, compliance investigation, implementation of compliance efforts, and regulatory compliance through monitoring regulatory changes. This individual contributor also provides support on projects including assisting in development and coordination of plans and coordinating with stakeholders.

• Pursues self-development and effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and customers; influencing others through technical explanations and examples; providing occasional mentoring to team members; listening and responding to, seeking, and addressing performance feedback; creating plans to capitalize on strengths and develop weaknesses; anticipating and responding to the needs of others; and adapting to and learning from change, difficulties, and feedback.


• Completes work assignments by applying up-to-date expertise in subject area to generate creative solutions; ensuring all procedures and policies are followed; leveraging an understanding of data, and resources to support projects or initiatives; collaborating cross-functionally to solve business problems; identifying and monitoring priorities, deadlines, and expectations; communicating progress and information; identifying, recommending, and implementing ways to address improvement opportunities; and escalating issues or risks as appropriate.


• Conducts company compliance activities under the guidance of more senior employees by providing support to internal and external stakeholders; applying established regulations and standards to compliance efforts; and documenting compliance activities.


• Assists with compliance reporting efforts by monitoring, and compiling compliance data and information to identify potential risks and remedies; researching, analyzing, and summarizing data; and reporting to senior team members on key compliance drivers, liabilities, and performance indicators (for example, adherence to standards, incorporation of new regulations).


• Assists with compliance investigation efforts by collecting and analyzing data; identifying misalignment with desired compliance actions; conducting interviews as appropriate; determining action steps for resolution; and providing input on corrective action plans.


• Provides support on projects by coordinating stakeholder contacts; assisting in the development, analysis, and coordination of project plans for compliance specific deliverables; and coordinating project schedules and resource forecasts.


• Assists with ensuring regulatory compliance by monitoring regulatory changes; acting on regulatory updates; and supporting the implementation of designated changes.


• Assists in the implementation of compliance efforts by identifying compliance requirements; supporting the assessment of current state compliance to identify gaps and corrective actions; supporting the creation or revision of basic compliance standards, policies and procedures, and training; and monitoring ongoing compliance adherence.

• Bachelors degree in Health Care Administration, Clinical, Law, Public Health, Business or related field and Minimum three (3) years experience in compliance, health care operations (quality, risk, etc.), audit, finance, regulatory or public policy development, investigations, information security, or insurance/health plan governance or a directly related field. Additional equivalent work experience in a directly related field may be substituted for the degree requirement.