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 adherence to regulatory standards while collaborating with various teams to enhance coding quality and compliance readiness.

Key responsibilities:

• Manage compliance reporting and investigations, analyzing data and identifying key compliance drivers
• Develop and implement the annual coding audit plan in collaboration with compliance teams
• Lead cross-functional projects to improve coding quality and compliance initiatives

Required qualifications:

• Minimum six (6) years of medical coding experience
• Minimum three (3) years 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 from recognized organizations
• Experience in health care compliance or operations, audit, finance, or regulatory development