California Licensed Compliance Manager

Job Summary

To support Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Manager will oversee compliance activities, manage coding validation and internal quality assurance reviews, and partner with various teams to enhance coding quality and ensure regulatory compliance while working remotely.

Key responsibilities:

• Manage compliance reporting efforts, evaluating compliance data and audit information, and conveying key findings to leadership
• Direct audit activities related to coding across all care settings, ensuring adherence to national coding policies and procedures
• Develop and present coding educational in-services and seminars while evaluating the quality of coding assignments across all lines of business

Required qualifications:

• Minimum five (5) years of medical coding experience
• Minimum two (2) 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 six (6) years of relevant experience
• Certified Risk Adjustment Coder, Certified Coding Specialist, or Certified Professional Coder