California Licensed Compliance Manager
Job Summary
To support Health Plan Risk Adjustment operations, the full-time remote California Licensed Compliance Manager will manage compliance oversight, audit readiness, and coding validation, ensuring regulatory compliance and coding integrity while collaborating with various teams to drive continuous improvement.
Key responsibilities:
- Manage compliance activities by partnering with stakeholders and overseeing the design and execution of strategic compliance initiatives
- Oversee compliance reporting and investigations, analyzing data and developing presentations for senior management on key compliance drivers and risks
- Develop and implement the annual coding audit plan, ensuring teams are educated on the latest coding developments and evaluating coding quality across business lines
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 organizations
- Experience in health care compliance, operations, audit, or related fields
Complete Job Description
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