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.

Key responsibilities:

• Manage compliance activities by partnering with stakeholders and overseeing the design and execution of strategic compliance initiatives
• Conduct coding validation and documentation reviews to ensure accurate risk capture and regulatory compliance
• Develop the annual coding audit plan and support audit activities to drive continuous improvement across Risk Adjustment programs

Required qualifications:

• Minimum six (6) years of medical coding experience
• Minimum three (3) years of experience 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, Certified Risk Adjustment Coder, or Certified Professional Coder certification
• Experience in health care compliance, operations, audit, or regulatory development