Coding Compliance Manager

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Full Time Corporate El Segundo, CA, US

Salary Range: $90,000.00 To $ Annually

• 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.

• Bachelor's degree in Health Information Management, Healthcare…