California Licensed Compliance Manager

Job Summary

To support Health Plan Risk Adjustment operations, the full-time salaried California Licensed Compliance Manager will oversee compliance activities, manage audit processes related to medical coding, and ensure adherence to regulatory standards while working remotely.

Key responsibilities:

• Manage compliance reporting and investigations, analyzing data and identifying key compliance drivers
• Develop and execute strategic compliance initiatives, ensuring alignment with regulations and operational standards
• Collaborate with cross-functional teams to enhance coding quality and support audit activities

Required qualifications:

• Minimum six (6) years of medical coding experience
• Minimum three (3) years of leadership experience in a relevant role
• Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business, or a related field, along with eight (8) years of experience in health care compliance or related areas
• Certified Coding Specialist or equivalent certification from recognized professional organizations
• Experience in health care operations, audit, finance, or regulatory compliance