California Licensed Compliance Manager

Job Summary

Supporting Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Manager will oversee government audit readiness, compliance oversight, and internal quality assurance reviews while managing coding validation and documentation analysis in a remote environment.

Key responsibilities

• Manage compliance activities by partnering with stakeholders and overseeing the design and execution of strategic compliance initiatives
• Develop and implement the annual coding audit plan, ensuring adherence to national coding policies and procedures
• Evaluate compliance data and audit results, reporting key findings and performance indicators to senior management

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 coding certification from recognized organizations
• Minimum eight (8) years of experience in health care compliance, operations, audit, or related fields