California Licensed Compliance Manager

Job Summary

To support Health Plan Risk Adjustment operations, the full-time remote California Licensed Compliance Manager will manage compliance oversight, audit readiness, and coding validation while partnering with various teams to enhance coding quality and ensure regulatory compliance.

Key responsibilities:

• Manage compliance activities by overseeing strategic initiatives and ensuring adherence to regulations and standards
• Develop and implement the annual coding audit plan, collaborating with reimbursement compliance teams and reviewing audit results
• Lead compliance investigations and manage the analysis of compliance data, identifying risks and recommending corrective actions

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 or equivalent certification from recognized professional organizations