California Licensed Compliance Manager

Job Summary

Supporting Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Manager will oversee compliance activities, manage coding audits, and ensure regulatory adherence while working remotely from authorized states.

Key responsibilities:

• Manage compliance activities by partnering with stakeholders and overseeing the design and execution of strategic compliance initiatives
• Conduct coding validation and documentation reviews to ensure accurate risk capture and compliance with national coding policies
• Develop and present educational inservices on coding and compliance topics 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 or Certified Coding Specialist from recognized professional organizations
• Experience in health care compliance, operations, audit, or regulatory policy development