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 compliance activities by partnering with stakeholders and overseeing the design and execution of compliance initiatives
• Conduct coding validation and documentation reviews to ensure accurate risk capture and compliance with coding policies
• Develop and present educational inservices and seminars on coding compliance and quality improvement initiatives

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