California Licensed Compliance Manager

Job Summary

To support Health Plan Risk Adjustment operations, the full-time remote California Licensed Compliance Manager will manage compliance activities, oversee coding validation and documentation review, and partner with operational and clinical teams to enhance coding quality and ensure regulatory compliance.

Key responsibilities:

• Manage compliance activities by partnering with stakeholders and overseeing strategic compliance initiatives
• Oversee coding validation and documentation reviews to ensure accurate risk capture and coding integrity
• Develop and implement the annual coding audit plan in collaboration with reimbursement compliance teams

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 with eight (8) years of relevant experience
• Certified Coding Specialist or equivalent certification from recognized organizations
• Experience in health care compliance, operations, audit, or regulatory policy development