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 cross-functional teams to enhance coding quality and mitigate risks.

Key responsibilities:

• Manage compliance activities and coding audits to ensure adherence to national coding policies and procedures
• Develop and execute the annual coding audit plan in collaboration with reimbursement compliance teams
• Analyze compliance data and report key findings to senior management and external stakeholders

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 related field with a minimum of eight (8) years in health care compliance or related areas
• Certified Coding Specialist or equivalent coding certification
• Experience in health care operations, audit, finance, or regulatory compliance