California Licensed Compliance Manager

Job Summary

To enhance Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Manager will oversee compliance activities, manage audit processes related to medical coding, and ensure regulatory adherence while working remotely.

Key responsibilities:

• Manage compliance activities by collaborating with internal and external stakeholders to design and implement strategic compliance initiatives
• Oversee coding validation, documentation review, and internal quality assurance reviews to ensure accurate risk capture and coding integrity
• Develop and present coding educational inservices 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 related field with six (6) years of relevant experience
• Certified Risk Adjustment Coder, Certified Coding Specialist, or Certified Professional Coder certification
• Experience in health care compliance, operations, audit, finance, or regulatory fields