Director, Coding Training & Compliance

Department: Revenue Cycle
Reports To: Sr. Director, RCM Operations
Travel: Up to 20% as needed

Position Summary

The Director, Coding Training & Compliance provides strategic and operational leadership for coding, charge entry, and education across Retina Consultants of America (RCA). This role is responsible for coding quality, charge entry operations, physician coding guidance and education, compliance, auditing, and standardization across the organization.

The Director partners closely with physicians, Revenue Cycle leadership, Training & Quality Assurance, practice leadership, and other key stakeholders to promote accurate coding and charge capture, strengthen physician documentation, and ensure consistent practices that support compliant and timely reimbursement.

Essential Duties and Responsibilities

• Provide enterprise leadership and oversight for coding and charge entry operations across RCA practices.
• Establish and maintain standardized coding and charge entry policies, procedures, workflows, and performance expectations.
• Oversee charge entry processes to support accurate, complete, and timely charge capture and claim submission.
• Establish and monitor coding and charge entry productivity, accuracy, quality, and charge lag benchmarks.
• Provide coding guidance and education to physicians regarding documentation, code selection, modifiers, medical necessity, and payer requirements.
• Serve as a coding subject matter expert for physicians and Revenue Cycle leadership on complex coding and reimbursement questions.
• Partner with physicians and practice leadership to identify documentation opportunities and improve coding accuracy and charge capture.
• Oversee coding audits and quality reviews to identify trends, compliance risks, education needs, and opportunities for improvement.
• Partner with Training & Quality Assurance to develop education based on audit findings, coding trends, denial trends, regulatory updates, and operational needs.
• Monitor changes to CPT, ICD-10-CM, HCPCS, NCCI edits, CMS requirements, and payer-specific coding policies and communicate operational impacts.
• Partner with Revenue Cycle leadership to identify coding- and charge-related denials, reimbursement issues, missed charges, and revenue leakage.
• Provide coding expertise for complex cases, payer disputes, audits, and escalations.
• Develop and monitor coding and charge entry KPIs, trends, and reporting for Revenue Cycle leadership.
• Support new physician onboarding by providing coding and documentation education and establishing coding expectations.
• Support new practice integrations and organizational growth by standardizing coding and charge entry workflows.
• Lead, develop, and mentor coding and charge entry leadership and team members while promoting accountability, collaboration, and continuous improvement.
• Collaborate with Compliance and other stakeholders to ensure coding and charge entry practices meet applicable federal, state, payer, and organizational requirements.
• Perform other duties and special projects as assigned.

Qualifications

Required

• Bachelor's degree in healthcare administration, business, health information management, or related field, or equivalent combination of education and relevant experience.
• 7+ years of billing and coding experience, with ophthalmology and retina experience.
• Minimum of 5 years of leadership experience in healthcare coding, billing, revenue cycle, or related function.
• Significant experience overseeing coding, billing, charge entry, quality, compliance, and/or auditing in an MSO healthcare organization.
• Strong working knowledge of CPT, ICD-10-CM, HCPCS, modifiers, NCCI edits, CMS guidelines, medical necessity requirements, and commercial payer coding requirements.
• Current professional coding certification such as CPC, CCS, or equivalent recognized coding credential.
• Demonstrated experience interpreting coding regulations and translating requirements into operational processes.
• Experience developing and monitoring coding and charge entry quality and productivity standards.
• Experience providing coding guidance and education to physicians and operational teams.
• Strong analytical skills with the ability to identify trends and develop actionable solutions.
• Demonstrated ability to lead teams and influence physicians, operational leaders, and cross-functional stakeholders.
• Strong written and verbal communication skills.
• Ability to travel as needed.

Preferred

• Advanced or additional certifications such as CPMA, COC, CRC, or specialty-specific coding credentials.
• Experience with physician coding education and clinical documentation improvement.
• Experience supporting coding operations across multiple practices, states, or legal entities.
• Experience supporting practice acquisitions, integrations, or centralized Revenue Cycle operations.
• Knowledge of coding and Revenue Cycle technology, including coding platforms, EHR/practice management systems, claim-editing tools, and reporting systems.

Knowledge, Skills & Abilities

• Strong knowledge of professional fee coding, charge capture, billing, and reimbursement principles.
• Strong understanding of physician documentation requirements and their impact on coding and reimbursement.
• Ability to communicate complex coding requirements clearly and effectively to physicians and non-coding audiences.
• Ability to interpret complex coding and payer requirements and provide practical operational guidance.
• Strong leadership, coaching, and team-development skills.
• Ability to balance coding accuracy, compliance, productivity, and financial performance.
• Strong problem-solving and analytical capabilities.
• Ability to manage multiple priorities in a fast-paced, growing organization.
• Ability to build effective partnerships across Revenue Cycle, Compliance, Operations, and clinical teams.
• High level of professionalism, judgment, integrity, and attention to detail.

Benefits:

• 401(k)
• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Paid time off
• Vision insurance

Work Location: Remote