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.