Coding Compliance Manager

JOB TITLE: CODING COMPLIANCE MANAGER (& PROVIDER EDUCATION)

REPORTS TO: DIRECTOR OF REVENUE CYLCLE MANAGEMENT (DIRECTOR RCM)

LOCATION: HYBRID REMOTE (Must be able to travel to El Segundo Home Office and Clinic Locations)

KEY RESPONSIBILITIES

Provider Coding Education

• Design, standardize, and manage a Provider Coding Education program for all new and existing physicians and advanced practice providers (NPs/PAs), including structured onboarding curriculum and ongoing/refresher education.
• Develop role-specific training content (E/M leveling, documentation requirements, modifier usage, urgent care-specific coding scenarios) and deliver it via live sessions, recorded modules, and job aids.
• Track education completion, coding accuracy trends by provider, and program effectiveness; report results to Clinical and RCM leadership.

Coding & Clinical Documentation Audit Program

• Develop, standardize, and manage a Coding and Clinical Documentation audit program covering both regular (scheduled/routine) and ad hoc audits.
• Build and maintain a risk-based annual audit plan and sampling methodology, informed by payer risk areas, denial trends, and OIG/CMS guidance.
• Manage coding auditors who execute the audit program; review findings for quality and consistency before they go to providers or leadership.
• Meet directly with Clinical Leaders and individual providers to deliver audit feedback, and address training, workflow, or documentation deficiencies identified through audits.
• Own corrective action plans for providers or coders with recurring accuracy issues, including escalation paths in partnership with Clinical Leadership and HR as needed.

Coding & Documentation Standards

• Establish and document coding and clinical documentation best practices, workflows, and policies in conjunction with Clinical Leaders.
• Monitor regulatory and payer guideline changes (CMS, AMA CPT, ICD-10-CM, California Medi-Cal, and commercial payer policies) and translate updates into provider- and coder-facing guidance.
• Partner with EMR/technology teams on templates, smart phrases, and clinical documentation tools that support accurate, compliant coding at the point of care.

Coding Operations & Team Management

• Directly manage the production coding team, including domestic Certified Professional Coders and offshore Task Force CPCs, ensuring productivity and quality standards are met per internal and vendor SLAs.
• Set and monitor coding quality/accuracy benchmarks, productivity targets, and quality assurance workflows for the coding team.
• Support recruiting, onboarding, and ongoing development of direct reports.

Revenue Cycle Partnership

• Partner with the RCM Manager and Director to review and address coding-related denials and underpayments, identifying root causes and durable fixes (documentation, coding, or system-based).
• Partner with organization leadership to evaluate new technologies (e.g., computer-assisted coding, AI-driven documentation or coding tools) and resources that support clinician documentation and coding workflows.
• Assist in configuring coding edits and claim-scrubbing rules within RCM systems to support clean claim submission and reduce front-end denials.
• Support provider education and EMR workflow training related to MIPS-related quality and documentation requirements.
• Support responses to payer coding audits, RADV requests, and other external chart review requests as needed.

QUALIFICATIONS

Required Experience & Education

• Bachelor's degree in Health Information Management, Healthcare Administration, or a related field, or equivalent combination of education and experience.
• 7+ years of progressive experience in professional-fee/outpatient coding, auditing, and compliance; urgent care, emergency medicine, or multi-specialty outpatient experience strongly preferred.
• 3+ years of experience directly managing coding staff and/or coding auditors.
• Demonstrated experience designing and delivering coding education programs directly to physicians and advanced practice providers.
• Deep working knowledge of CPT, ICD-10-CM, HCPCS Level II, E/M documentation guidelines, and CMS/payer documentation requirements.
• Experience partnering with clinical leadership to resolve documentation and coding issues, and driving provider behavior change.
• Experience analyzing coding-related denials and underpayments and translating findings into process or education fixes.

Required or Preferred Certifications (must hold at least one; multiple strongly preferred)

• Certified Professional Coder (CPC) - AAPC
• Certified Professional Medical Auditor (CPMA) - AAPC
• Certified Outpatient Coder (COC) - AAPC
• Certified Documentation Expert Outpatient (CDEO) - AAPC

Preferred Experience

• Prior experience in urgent care, emergency medicine, or high-volume outpatient episodic care coding.
• Experience managing or partnering with an offshore/outsourced coding team.
• Familiarity with MIPS/MACRA quality reporting workflows within an EMR.
• Experience supporting a revenue cycle system implementation or conversion (Enter Health experience a plus).
• Project management experience or certification (e.g., PMP, CAPM).

Other Requirements

• Must reside in California
• Comfortable working hybrid remote, with occasional travel to Southern California clinics and corporate meetings.