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.

Key responsibilities:

• Manage and direct audit activity related to medical coding, ensuring compliance with national coding policies
• Develop and present coding educational in-services and seminars while evaluating the quality of coding assignments
• Partner with operational, clinical, and compliance teams to identify risks and improve coding quality across Risk Adjustment programs

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 equivalent certification from recognized organizations
• Experience in health care compliance, audit, and regulatory or public policy development