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 driving continuous improvement in coding quality and risk capture.

Key responsibilities

• Manage compliance activities by collaborating with internal and external stakeholders and overseeing strategic compliance initiatives
• Direct audit activities related to coding functions, ensuring adherence to national coding policies and procedures
• Develop and implement the annual coding audit plan, reviewing audit results and guiding focused projects based on outcomes

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, along with eight (8) years of relevant experience
• Certified Coding Specialist from the American Health Information Management Association or equivalent coding certification
• Experience in health care compliance, operations, audit, finance, or regulatory development