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 ensure regulatory compliance while collaborating with various teams to enhance coding quality and audit readiness.

Key Responsibilities

• Manage compliance activities by partnering with stakeholders and overseeing strategic compliance initiatives
• Develop and execute the annual coding audit plan, ensuring teams are educated on the latest coding developments
• Evaluate compliance data and audit information to identify risks and report key findings to senior management

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 with eight (8) years of relevant experience
• Certified Coding Specialist from the American Health Information Management Association OR Certified Risk Adjustment Coder from the American Academy of Professional Coders OR Certified Professional Coder from the American Academy of Professional Coders