Coding Compliance Manager

Exer Medical Corporation•El Segundo, CA

2d•Hybrid

About The Position

The Coding Compliance Manager (& Provider Education) is responsible for designing, standardizing, and managing a Provider Coding Education program for all new and existing physicians and advanced practice providers. This role also involves developing, standardizing, and managing a Coding and Clinical Documentation audit program, establishing coding and clinical documentation best practices, and directing the production coding team. The position requires partnership with Revenue Cycle Management to address coding-related denials and underpayments, and support for provider education related to MIPS requirements. The role also involves assisting in configuring coding edits and claim-scrubbing rules, and supporting responses to payer coding audits.

Requirements

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.
Certified Professional Coder (CPC) - AAPC
Certified Professional Medical Auditor (CPMA) - AAPC
Certified Outpatient Coder (COC) - AAPC
Certified Documentation Expert Outpatient (CDEO) - AAPC
Must reside in California
Comfortable working hybrid remote, with occasional travel to Southern California clinics and corporate meetings.

Nice To Haves

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 (Epic Health experience a plus).
Project management experience or certification (e.g., PMP, CAPM).

Responsibilities

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.
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.
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.
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.
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.