California Licensed Compliance Manager

Job Summary

To support Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Manager will oversee compliance oversight, audit readiness, and quality assurance reviews while managing coding validation and documentation to ensure regulatory compliance and coding integrity in a remote environment.

Key responsibilities:

• Manage compliance activities by partnering with stakeholders and overseeing the design and execution of strategic compliance initiatives
• Develop and present coding educational inservices and seminars while evaluating the quality of coding assignments across all lines of business
• Lead compliance investigations and manage compliance reporting efforts, identifying key compliance drivers and potential risks

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 a minimum of six (6) years of relevant experience
• Certified Risk Adjustment Coder, Certified Coding Specialist, or Certified Professional Coder
• Experience in health care compliance, operations, audit, or regulatory policy development