Coding Compliance Manager

Salary Range: $90,000.00 To $120,000.00 AnnuallyJOB 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) - AAPCCertified Professional Medical Auditor (CPMA) - AAPCCertified Documentation Expert Outpatient (CDEO) - AAPCPreferred 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.