California Licensed Compliance Manager

Job Summary

To support Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Manager will oversee compliance oversight, coding validation, and audit readiness while collaborating with operational and clinical teams to enhance coding quality and ensure regulatory compliance in a remote work environment.

Key responsibilities:

• Manage compliance activities by partnering with stakeholders and overseeing the design and execution of strategic compliance initiatives
• Develop and implement the annual coding audit plan, ensuring adherence to national coding policies and procedures
• Evaluate compliance data and audit results, reporting key findings and recommendations to senior management

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, along with six (6) years of relevant experience
• Certified Risk Adjustment Coder, Certified Coding Specialist, or Certified Professional Coder certification