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 audits, and ensure regulatory adherence while working remotely from an authorized state.

Key responsibilities

• Manage compliance reporting efforts and evaluate compliance data, audit information, and potential risks
• Oversee coding validation, documentation reviews, and data-driven analysis to ensure accurate risk capture and coding integrity
• Develop and present coding educational inservices and seminars while collaborating with operational, clinical, and compliance teams

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
• Experience in health care compliance, health care operations, audit, finance, regulatory, or public policy development