California Licensed Compliance Manager

Job Summary

Supporting Health Plan Risk Adjustment operations, the full-time remote California Licensed Compliance Manager will manage audit readiness, compliance oversight, and coding validation to ensure regulatory compliance and coding integrity while collaborating with operational and clinical teams.

Key responsibilities:

• Oversee compliance activities and manage the design and execution of strategic compliance initiatives
• Develop and manage the annual coding audit plan, ensuring adherence to national coding policies
• Conduct coding validation and documentation reviews to improve coding quality and support audit activities

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
• Certified Coding Specialist or equivalent coding certification
• Minimum eight (8) years of experience in health care compliance, operations, audit, or related fields