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 collaborate with various teams to ensure regulatory compliance and coding integrity.

Key responsibilities:

• Manage compliance activities and ensure adherence to national coding policies and procedures
• Oversee coding validation, documentation review, and data-driven analysis to enhance risk capture and coding quality
• 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
• Certified Coding Specialist or equivalent certification from recognized organizations
• Minimum eight (8) years of experience in health care compliance, operations, audit, or related fields