California Licensed Compliance Manager

Job Summary

To support Health Plan Risk Adjustment operations, the full-time remote California Licensed Compliance Manager will oversee compliance activities, manage coding audits, and ensure regulatory adherence while collaborating with various teams to enhance coding quality and drive continuous improvement.

Key responsibilities:

• Manage compliance reporting and investigations, analyzing data and recommending corrective actions for identified risks
• Develop and implement the annual coding audit plan in collaboration with compliance teams, ensuring alignment with regulatory standards
• Lead cross-functional projects related to compliance, managing stakeholder engagement and project execution

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 with eight (8) years of relevant experience
• Certified Coding Specialist or equivalent certification in coding
• Experience in health care compliance, operations, or audit functions