California Licensed Compliance Manager

Job Summary

Supporting Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Manager will oversee government audit readiness, compliance oversight, and internal quality assurance reviews while working remotely.

Key responsibilities:

• Manage compliance activities by partnering with stakeholders and overseeing the design and execution of strategic compliance initiatives
• Conduct coding validation and documentation reviews to ensure accurate risk capture and regulatory compliance
• Develop and manage the annual coding audit plan, collaborating with reimbursement compliance teams and driving continuous improvement across Risk Adjustment programs

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
• Experience in health care compliance, audit, or regulatory policy development