Senior Risk Adjustment Compliance & Coding Lead

Kaiser Permanente; Pasadena (CA); On-site; USD 120,000 - 180,000; Full time

Job summary

Kaiser Permanente is seeking a risk adjustment compliance professional to support government audit readiness, coding validation, and regulatory oversight. The role partners with clinical, operational, and compliance teams to strengthen coding quality and ensure adherence to national policies across all care settings.

Responsibilities include leading investigations, presenting audit results to regional staff and senior management, and driving improvements in risk adjustment programs.

Qualifications

• Minimum six years of medical coding experience.
• Minimum three years in a leadership role.
• Bachelor's degree plus eight years in health care compliance, operations, audit, or related field; substitute experience for degree.

Responsibilities

• Support risk adjustment operations through audit readiness, compliance oversight, and QA reviews.
• Perform coding validation, documentation review, and data-driven analysis for accurate risk capture and regulatory compliance.
• Partner with cross-functional teams to identify risks and drive continuous improvement across programs.
• Serve as compliance SME across care settings and present audit results to leadership.
• Lead compliance reporting by summarizing data, risks, and performance indicators.

Skills

Medical coding

Leadership

Regulatory compliance

Audit coordination

Education

Bachelor's degree in Health Care Administration or related field

Certified Coding Specialist (CCS)

Certified Risk Adjustment Coder (CRC)

Certified Professional Coder (CPC)

Job description

Kaiser Permanente is seeking a risk adjustment compliance professional to support government audit readiness, coding validation, and regulatory oversight. The role partners with clinical, operational, and compliance teams to strengthen coding quality and ensure adherence to national policies across all care settings.

Responsibilities include leading investigations, presenting audit results to regional staff and senior management, and driving improvements in risk adjustment programs.