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 reviews, and ensure audit readiness while collaborating with cross-functional teams to enhance coding quality and regulatory compliance.
Key responsibilities:
- Manage compliance reporting efforts and evaluate compliance data, audit information, and potential risks
- Oversee the design, development, and execution of strategic compliance initiatives related to medical coding
- Develop the annual coding audit plan and support compliance investigations across business functions
Required qualifications:
- Minimum six (6) years of medical coding experience
- Minimum three (3) years of leadership experience
- Bachelor's degree in a related field and a minimum of eight (8) years in health care compliance or related areas
- Certified Coding Specialist or equivalent coding certification
- Experience in health care operations, audit, or regulatory compliance
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