California Licensed Compliance Manager

Job Summary

Focusing on compliance oversight and audit readiness, the full-time remote California Licensed Compliance Manager will support Health Plan Risk Adjustment operations by managing coding validation, documentation review, and data analysis to ensure regulatory compliance and coding integrity.

Key responsibilities:

• Manage compliance activities by partnering with stakeholders and overseeing the execution of strategic compliance initiatives
• Conduct coding audits and develop the annual coding audit plan in collaboration with reimbursement compliance teams
• Oversee compliance reporting and investigations, analyzing data and recommending corrective actions for identified issues

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
• Minimum eight (8) years of experience in health care compliance, operations, audit, finance, or a related field
• Certification as a Coding Specialist or Risk Adjustment Coder from recognized professional organizations