Compliance Consultant IV, Medical Coding - Risk Adjustment

Open to candidates residing in any KP authorized state: CA, OR, WA, CO, GA, VA, HI, MD & D.C. Salary ranges are geographically based; the posted range reflects the Northern CA region. Lower salary ranges apply for other labor markets outside of NCAL.

About the Role

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.

Serve 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. Assist with the development of audit result reports to regional staff and senior management and support compliance and the Principles of Responsibility (KP’s code of conduct).

Responsibilities

• Practice self-development and promote learning in others by proactively providing information, resources, advice, and expertise with coworkers and customers; build relationships with cross-functional stakeholders; influence others through technical explanations and examples; adapt to competing demands and new responsibilities; listen and respond to, seek, and address performance feedback; provide feedback to others; create and execute plans to capitalize on strengths and develop weaknesses; support team collaboration; and adapt to and learn from change, difficulties, and feedback.
• Complete work assignments and support business-specific projects by applying expertise in subject area; support the development of work plans to meet business priorities and deadlines; ensure the team follows all procedures and policies; coordinate resources to accomplish priorities and deadlines; collaborate cross-functionally to make effective business decisions; solve complex problems; escalate high-priority issues or risks as appropriate; and recognize and capitalize on improvement opportunities.
• Conduct company compliance activities by collaborating with internal and external stakeholders; apply established regulations and standards to compliance efforts; provide insight and recommendations for the design, development, and execution of strategic compliance initiatives; and document compliance activities.
• Develop compliance reports by evaluating and summarizing compliance data, audit information, and potential risks and remedies; report to management on key compliance drivers, liabilities, and performance indicators (e.g., adherence to standards, incorporation of new regulations); and develop draft presentations to convey key findings.
• Conduct compliance investigations by collecting and analyzing quantitative and qualitative data; conduct interviews as appropriate; research key business issues; identify potential action steps; and provide input for the creation of corrective action plans for substantiated allegations.
• Assist with and support the management of projects or compliance components of larger cross-functional projects by coordinating stakeholder contacts; recommend team resources based on project needs and team member strengths; assist in the development, analysis, and management of project plans; and coordinate project schedules and resource forecasts.
• Assist with ensuring regulatory compliance by monitoring regulatory changes; conduct analysis on regulatory impacts; and support the implementation of designated changes.
• Coordinate the implementation of compliance efforts by identifying compliance requirements; assess the current state of compliance to identify gaps and corrective actions; create or revise moderately complex compliance standards, policies and procedures, and training; and monitor ongoing compliance adherence.

Requirements

• Minimum four (4) years of medical coding experience.
• Bachelor’s degree in Health Care Administration, Clinical, Law, Public Health, Business, or related field and minimum six (6) years of 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 (AAPC) or Certified Coding Specialist (AHIMA) or Certified Professional Coder (AAPC).

Preferred Qualifications

• Four (4) years of hospital coding experience.
• Four (4) years of coding audit experience.

Schedule

• Full-time
• Monday–Friday
• 8:00 AM–5:00 PM
• 40 hours per week

Pay

$106,900 – $138,270 per year (Northern CA region). Actual base pay determined at offer based on labor market data, internal alignment, and a candidate’s years of relevant work experience, education, certifications, skills, and geographic location.

Work Setting

• Remote (worker location must align with Kaiser Permanente’s Authorized States policy)
• No travel required