California Licensed Compliance Manager

Job Summary

Supporting Health Plan Risk Adjustment operations, the full-time California Licensed Compliance Manager will oversee compliance activities, manage audit processes related to medical coding, and collaborate with various teams to ensure regulatory compliance and coding integrity in a remote environment.

Key responsibilities:

• Manage compliance reporting efforts by evaluating compliance data, audit information, and potential risks
• Direct coding validation and documentation reviews to ensure accurate risk capture and coding integrity
• Develop and implement the annual coding audit plan in collaboration with compliance teams and oversee audit activities

Required qualifications:

• Minimum six (6) years of medical coding experience
• Minimum three (3) years 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 or equivalent certification from recognized organizations
• Experience in health care compliance, operations, audit, or regulatory policy development