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 audit processes related to medical coding, and ensure adherence to regulatory standards while collaborating with cross-functional teams.

Key responsibilities:

• Manage compliance reporting and investigations across business functions, analyzing data and recommending corrective actions
• Develop and execute the annual coding audit plan, ensuring alignment with national coding policies and procedures
• Lead cross-functional projects to enhance coding quality and support continuous improvement initiatives

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 from the American Health Information Management Association or equivalent certification
• Experience in health care compliance, operations, audit, or regulatory development