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 coding audits, and ensure regulatory adherence while collaborating with various teams to improve coding quality and drive continuous improvement.

Key responsibilities:

• Manage compliance reporting efforts, evaluating compliance data and identifying key performance indicators for senior management
• Oversee coding validation and documentation review to ensure accurate risk capture and compliance with national coding policies
• Develop and implement strategic compliance initiatives, partnering with stakeholders to ensure adherence to regulations and standards

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
• Minimum eight (8) years of experience in health care compliance, operations, audit, finance, or related fields
• Certification as a Certified Coding Specialist, Certified Risk Adjustment Coder, or Certified Professional Coder