California Licensed Compliance Manager

Job Summary

To enhance 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 reporting and investigations across business functions, analyzing data and presenting findings to leadership
• Develop and execute the annual coding audit plan, ensuring compliance with national coding policies and procedures
• Collaborate with operational, clinical, and compliance teams to identify risks and improve coding quality

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 a related field, along with eight (8) years of relevant experience
• Certified Coding Specialist or equivalent certification from recognized professional organizations