California Licensed Compliance Manager

Job Summary

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

Key responsibilities:

• Manage compliance activities by collaborating with stakeholders and overseeing strategic compliance initiatives
• Conduct coding validation and documentation review to ensure accurate risk capture and coding integrity
• Develop and implement the annual coding audit plan, reviewing audit results and driving continuous improvement

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 with a minimum of eight (8) years in health care compliance or related areas
• Certified Coding Specialist or equivalent certification from recognized organizations