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Title: Supervisor, Coding Compliance

Location: Fountain Valley

Department: Document Improvement

Status: Full Time

Shift: Exempt

Pay Range*: $89,710.40 - $130,104.00/annually

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups - consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Position Summary

The Coding Compliance Supervisor is responsible for overseeing coding compliance, auditing, education, quality assurance, and daily professional services coding operations. This position provides direct supervision and leadership to coding staff while ensuring coding accuracy, regulatory compliance, operational efficiency, reimbursement optimization, and professional staff development. The role supports professional services coding across both hospital-based and ambulatory settings, including provider-based departments, outpatient clinics, inpatient/observation encounters, emergency department, procedural services, and other professional billing environments where physician or qualified health care professional services are reported. The Coding Compliance Supervisor serves as a subject-matter expert and operational resource for coding staff and providers supporting organizational goals and promoting a culture of quality, accountability, and continuous improvement.

Essential Functions and Responsibilities of the Job

• Oversee and support professional services coding for hospital and ambulatory encounters, including office/clinic visits, inpatient and observation professional services, emergency department professional services, procedures, surgeries, diagnostic services, and other physician or qualified health care professional services. Ensure accurate CPT, ICD-10-CM, HCPCS Level II, modifier, E/M, and place-of-service assignment based on documentation, payer rules, regulatory requirements, and applicable coding guidelines.

• Monitor professional coding work queues, claim edits, coding-related denials, payer rejections, and backlog trends to support timely charge capture, clean claim submission, reimbursement integrity, and compliant resolution of coding issues.

• Develop, coordinate, and deliver coder and provider education related to professional services documentation and coding, including E/M selection, medical decision making, time-based coding when applicable, split/shared or team-based services, modifier usage, medical necessity, specialty-specific coding, annual code set updates, and payer policy changes.

• Collaborate with providers, practice leadership, hospital-based departments, ambulatory clinic teams, revenue cycle, compliance, CDI, HIM, revenue integrity, billing, and system support teams to resolve documentation, coding, charge capture, and reimbursement issues impacting professional services claims.

• Maintain current knowledge of applicable federal, state, payer, and organizational requirements, including CMS guidance, OIG compliance expectations, CPT, ICD-10-CM, HCPCS, E/M documentation standards, payer policies, and internal coding compliance standards.

• Oversee coding-related Epic workflows, including professional coding work queues, charge review, claim edits, coding status monitoring, encounter correction processes, charge capture workflows, and escalation of system or workflow issues impacting professional services coding, clean claim submission, compliance, or reimbursement accuracy.

• Utilize Epic reporting tools, dashboards, work queue metrics, audit data, denial trends, productivity reports, and coding quality indicators to monitor team performance, identify trends, support operational decision-making, and drive process improvement.

• Collaborate with Epic system support, revenue integrity, billing, compliance, clinical operations, CDI, HIM, provider leadership, and practice leadership to evaluate coding-related system functionality, documentation tools, charge capture logic, claim edits, templates, preference lists, SmartTools, order-to-charge workflows, payer rule changes, annual coding updates, testing, and implementation of workflow enhancements.

• Provide daily supervisory leadership to coding staff, including workload assignment, productivity review, quality oversight, work queue aging review, onboarding, training, staff development, performance coaching, documentation of follow-up, and support of corrective action processes when appropriate.

• Develop, maintain, and support coding audit governance processes, including audit methodology, sampling approach, documentation of findings, provider and coder feedback, corrective action plans, follow-up audits, trend reporting, and escalation of potential compliance risks through appropriate channels.

• Identify, research, document, and escalate professional coding compliance concerns, including documentation insufficiency, modifier misuse, E/M leveling concerns, medical necessity issues, payer policy interpretation, bundling or unbundling risk, upcoding or downcoding risk, duplicate billing, under-coding, over-coding, and other professional billing risk areas.

• Support change management activities related to Epic upgrades, annual code set updates, payer policy changes, new providers, new specialties, new service lines, integrations, acquisitions, workflow redesign, and implementation of coding-related operational changes.

• Ensure appropriate access, use, handling, and protection of protected health information within Epic and related coding, billing, reporting, and audit systems in accordance with HIPAA, organizational privacy standards, and information security requirements.

• "Other duties as assigned"

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare-that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there's more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards.

Minimum Requirements

Qualifications/Work Experience:

• A minimum of 5 years of professional experience in medical coding, including at least 2 years in a leadership or supervisory role.

• Experience with professional billing coding in both hospital-based and ambulatory settings is strongly preferred, including experience with E/M coding, procedural coding, modifiers, payer edits, coding denials, documentation improvement, and provider education across multiple specialties.

• Experience working in an Epic EHR and professional billing environment is strongly preferred, including experience with Epic coding work queues, charge review, claim edits, reporting, dashboards, encounter correction workflows, and collaboration with system support or revenue integrity teams.

Education/Licensure/Certification:

• An associate or bachelor's degree in health information management, healthcare administration, or a related field is preferred.

• Required: AAPC CPC or AHIMA CCS-P certification

• Preferred additional certifications may include CPMA, CEMC, CRC, CCS, RHIT, RHIA, or specialty coding credentials relevant to professional services, auditing, compliance, or provider education.