California Licensed Compliance Manager

Job Summary

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

Key responsibilities:

• Manage compliance activities by partnering with stakeholders and overseeing the execution of strategic compliance initiatives
• Develop and implement the annual coding audit plan, ensuring adherence to national coding policies and procedures
• Lead compliance investigations and manage the evaluation of compliance data, identifying risks and recommending corrective actions

Required qualifications:

• Minimum six (6) years of medical coding experience
• Minimum three (3) years in a leadership role
• Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business, or related field, along with eight (8) years of relevant experience
• Certified Coding Specialist or equivalent certification from recognized professional organizations
• Experience in health care compliance, operations, audit, or regulatory policy development