California Licensed Compliance Manager

Job Summary

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

Key responsibilities:

• Manage compliance activities by partnering with stakeholders and overseeing strategic compliance initiatives
• Develop and execute the annual coding audit plan, ensuring adherence to national coding policies
• Evaluate and report on compliance data, audit results, and potential risks to senior management

Required qualifications:

• Minimum six (6) years of medical coding experience
• Minimum three (3) years of leadership experience, with or without direct reports
• 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 organizations