California Licensed Compliance Manager

Job Summary

To support Health Plan Risk Adjustment operations, the full-time remote California Licensed Compliance Manager will oversee compliance activities, manage audit processes related to medical coding, and ensure adherence to regulations while driving continuous improvement across Risk Adjustment programs.

Key responsibilities:

• Manage compliance reporting efforts and evaluate compliance data, audit information, and potential risks
• Direct audit activities related to coding and ensure 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, Certified Risk Adjustment Coder, or Certified Professional Coder certification
• Experience in health care compliance, health care operations, audit, finance, or regulatory development