California Licensed Compliance Manager

Job Summary

Supporting Health Plan Risk Adjustment operations, the full-time remote California Licensed Compliance Manager will manage compliance oversight, coding validation, and internal quality assurance reviews while partnering with various teams to ensure regulatory compliance and improve coding quality.

Key responsibilities:

• Manage compliance activities by applying regulations and overseeing strategic compliance initiatives
• Conduct coding validation and documentation reviews to ensure accurate risk capture and coding integrity
• Develop and implement the annual coding audit plan in collaboration with compliance teams

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 with eight (8) years of relevant experience
• Certified Coding Specialist or equivalent coding certification
• Experience in health care compliance or operations, audit, or regulatory policy development