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 validation and documentation reviews, and collaborate with operational and clinical teams to enhance coding quality and ensure regulatory compliance.

Key responsibilities:

• Manage compliance reporting efforts by evaluating compliance data and audit information, and reporting key findings to senior management
• Oversee the development and execution of strategic compliance initiatives, ensuring adherence to regulations and standards
• Serve as a compliance subject matter expert, directing audit activities related to coding and ensuring teams are educated on the latest coding developments

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 experience in health care compliance or related areas
• Certified Coding Specialist or equivalent certification from recognized professional organizations