Care Operations Specialist

<div class="content-intro">Who we are  Transcarent and Accolade have come together to create the One Place for Health and Care, the leading personalized health and care experience that delivers unmatched choice, quality, and outcomes. Transcarent’s AI-powered WayFinding, comprehensive Care Experiences – Cancer Care, Surgery Care, Weight – and Pharmacy Benefits offerings combined with Accolade’s health advocacy, expert medical opinion, and primary care, allows us to meet people wherever they are on their health and care journey. Together, more than 20 million people have access to the combined company’s offerings. Employers, health plans, and leading point solutions rely on us to provide trusted information, increase access, and deliver care.We are looking for teammates to join us in building our company, culture, and Member experience who:  <ul><li data-leveltext="" data-font="Symbol" data-listid="1" data-list-defn-props="{"335552541":1,"335559684":-2,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">Put people first, and make decisions with the Member’s best interests in mind </li><li data-leveltext="" data-font="Symbol" data-listid="1" data-list-defn-props="{"335552541":1,"335559684":-2,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="2" data-aria-level="1">Are active learners, constantly looking to improve and grow </li><li data-leveltext="" data-font="Symbol" data-listid="1" data-list-defn-props="{"335552541":1,"335559684":-2,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="3" data-aria-level="1">Are driven by our mission to measurably improve health and care each day </li><li data-leveltext="" data-font="Symbol" data-listid="1" data-list-defn-props="{"335552541":1,"335559684":-2,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="4" data-aria-level="1">Bring the energy needed to transform health and care, and move and adapt rapidly </li><li data-leveltext="" data-font="Symbol" data-listid="1" data-list-defn-props="{"335552541":1,"335559684":-2,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="5" data-aria-level="1">Are laser focused on delivering results for Members, and proactively problem solving to get there </li></ul></div>About this Role The Care Operations Specialist is responsible for the operational aspects of our SurgeryCare solution, ensuring the delivery of exceptional surgery care experiences to our members. In this role, you will leverage your coding expertise to ensure proper case placement in accordance with plan rules and requirements, as well as review post-service claims coding for accuracy, medical necessity, and appropriateness of care. You will serve as a key liaison between our externally facing Care Support Services team and our internal clinical specialists, billing associates, and client and provider relationship managers. Effective communication and collaboration will be critical in managing operational processes and resolving escalations, as well as implementing strategies to improve the quality, effectiveness, and cost-efficiency of our care program. The ideal candidate is excited to roll up their sleeves to dive into details to ensure operational excellence and member satisfaction, as well as serve as a strategic operator and business partner for internal stakeholders across the organization.    What you'll do  <ul><li>Execute day-to-day internal operations of our SurgeryCare product, ensuring seamless member case placement through post-service claims collection and review  </li><li>Collaborate closely with our Care Support Services team to efficiently manage case placement workload, ensuring timely, accurate, and compliant completion of deliverables in line with company and plan policies and procedures </li><li>Accurately assign CPT codes to patient cases, ensuring proper coding for diagnosis, procedures, and treatments  </li><li>Review post-service claims coding for accuracy, medical necessity and appropriateness of care to minimize billing issues, discrepancies, and delays  </li><li>Communicate effectively with internal operations and management teams to identify and resolve issues, escalations, and delays   </li><li>Develop and implement coding policies, guidelines, and standard operating procedures (SOPs) that comply with legal, ethical, and regulatory requirements (e.g., HIPAA, CMS guidelines)  </li></ul>What we’re looking for  <ul><li>Bachelor’s degree in healthcare or a related field  </li><li>5+ years related work experience in medical coding, healthcare operations, or revenue cycle management, experience with episodic bundles preferred  </li><li>Active medical coding certification required - Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Medical Coder (CMC), or equivalent  </li><li>Deep understanding of medical coding - CPTs, HCPCs, DRGs, ICD-10, etc.  </li><li>Experience with medical billing and claims auditing, as well as working with providers and carriers/TPAs  </li><li>Comfortable working independently and as part of a team, with minimal direct supervision  </li><li>Results-oriented – experience achieving daily metrics and adhering to internal turnaround times  </li><li>Excellent interpersonal and communication skills; willingness to speak up, ask questions, or request clarity when something is unclear  </li><li>Highly organized and detail-oriented; follows standard policies and procedures, but can adapt and problem-solve through non-standard situations or escalate when appropriate    </li><li>Comfortable in a fast-paced and evolving organization with a willingness to be flexible and support occasional after-hours work to address urgent operational issues</li></ul><div class="content-pay-transparency"><div class="pay-input"><div class="title">As a remote position, the salary range for this role is:</div><div class="pay-range">$60,000—$70,000 USD</div></div></div><div class="content-conclusion">Total Rewards Individual compensation packages are based on a few different factors unique to each candidate, including primary work location and an evaluation of a candidate’s skills, experience, market demands, and internal equity.  Salary is just one component of Transcarent's total package. All regular employees are also eligible for the corporate bonus program or a sales incentive (target included in OTE) as well as stock options.  Our benefits and perks programs include, but are not limited to:  <ul><li data-leveltext="" data-font="Symbol" data-listid="1" data-list-defn-props="{"335552541":1,"335559684":-2,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">Competitive medical, dental, and vision coverage  </li><li data-leveltext="" data-font="Symbol" data-listid="1" data-list-defn-props="{"335552541":1,"335559684":-2,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">Competitive 401(k) Plan with a generous company match  </li><li data-leveltext="" data-font="Symbol" data-listid="1" data-list-defn-props="{"335552541":1,"335559684":-2,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="2" data-aria-level="1">Flexible Time Off/Paid Time Off, 12 paid holidays  </li><li data-leveltext="" data-font="Symbol" data-listid="1" data-list-defn-props="{"335552541":1,"335559684":-2,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="3" data-aria-level="1">Protection Plans including Life Insurance, Disability Insurance, and Supplemental Insurance </li><li data-leveltext="" data-font="Symbol" data-listid="1" data-list-defn-props="{"335552541":1,"335559684":-2,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="4" data-aria-level="1">Mental Health and Wellness benefits  </li></ul>Location  You must be authorized to work in the United States. Depending on the position we may have a preference to a specific location, but are generally open to remote work anywhere in the US.  Transcarent is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out!  Research shows that candidates from underrepresented backgrounds often don’t apply unless they meet 100% of the job criteria. While we have worked to consolidate the minimum qualifications for each role, we aren’t looking for someone who checks each box on a page; we’re looking for active learners and people who care about disrupting the current health and care with their unique experiences.  </div>

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