[Hiring] Compliance Consultant IV, Medical Coding - Risk Adjustment @Kaiser Permanente

Role Description

Support Health Plan Risk Adjustment operations through government audit readiness, compliance oversight, and internal quality assurance reviews. Perform coding validation, documentation review, and data-driven analysis to ensure accurate risk capture, regulatory compliance, and coding integrity. Partner with operational, clinical, and compliance teams to identify risks, improve coding quality, support audit activities, and drive continuous improvement across Risk Adjustment programs.

In addition to the responsibilities listed below, the position is responsible for serving as a compliance subject matter expert related to coding functions within all settings of care, maintaining compliance with national coding policies and procedures, assisting with coding questions and related topics, and auditing all lines of business for coding. Additionally, this position is responsible for assisting with the development of audit result reports to regional staff and senior management and supporting compliance and the Principles of Responsibility (KPs code of conduct).

Qualifications

• Minimum four (4) years medical coding experience.
• Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business or related field.
• Minimum six (6) years experience in health care 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.
• Certified Risk Adjustment Coder from American Academy of Professional Coders OR Certified Coding Specialist from American Health Information Management Association OR Certified Professional Coder from American Academy of Professional Coders.

Requirements

• Practices self-development and promotes learning in others by proactively providing information, resources, advice, and expertise with coworkers and customers.
• Completes work assignments and supports business-specific projects by applying expertise in subject area.
• Conducts company compliance activities by collaborating with internal and external stakeholders.
• Develops compliance reports by evaluating and summarizing compliance data, audit information, and potential risks and remedies.
• Conducts compliance investigations by collecting and analyzing quantitative and qualitative data.
• Assists with and supports the management of projects or compliance components of larger cross-functional projects.
• Assists with ensuring regulatory compliance by monitoring regulatory changes.
• Coordinates the implementation of compliance efforts by identifying compliance requirements.

Company Description