California Licensed Compliance Manager

Job Summary

To support Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Manager will oversee compliance activities related to medical coding, ensuring audit readiness, regulatory compliance, and coding integrity while working remotely.

Key responsibilities:

• Manage compliance activities by collaborating with internal and external stakeholders, ensuring adherence to regulations and standards
• Oversee the development and execution of the annual coding audit plan, including reporting audit results and identifying improvement opportunities
• Lead training and development initiatives for coding staff, fostering professional growth and compliance knowledge within the team

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 experience in healthcare compliance or related areas
• Certified Risk Adjustment Coder, Certified Coding Specialist, or Certified Professional Coder credentials
• Experience in healthcare operations, audit, finance, or regulatory compliance is preferred