California Licensed Compliance Manager

Job Summary

To support 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, analyzing data and developing corrective action plans
• Oversee the design and execution of strategic compliance initiatives in collaboration with internal and external stakeholders
• Develop and implement the annual coding audit plan, ensuring compliance with national coding policies and improving coding quality

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 a related field with eight (8) years of relevant experience
• Certified Coding Specialist from AHIMA or equivalent coding certification
• Experience in healthcare compliance, operations, audit, or regulatory fields