California Licensed Compliance Manager

Job Summary

Managing compliance activities for Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Manager will oversee coding validation, documentation review, and data-driven analysis to ensure regulatory compliance and coding integrity, while working remotely from an authorized KP state.

Key responsibilities:

• Oversee compliance reporting efforts, evaluating compliance data and identifying key performance indicators for senior management
• Manage the development and execution of the annual coding audit plan, collaborating with reimbursement compliance teams
• Serve as a subject matter expert on coding functions, directing audit activities and providing coding education and training

Required qualifications:

• Minimum five (5) years of medical coding experience
• Minimum two (2) years 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, audit, or regulatory policy development