Care Operations Specialist
Transcarent
Who we are
Transcarent is the One Place for Health and Care. We cut through complexity, making it easy for people to access high-quality, affordable health and care. We create a personalized experience tailored for each Member, including an on-demand care team, and a connected ecosystem of high-quality, in-person care and virtual point solutions. Transcarent eliminates the guesswork and empowers Members to make better decisions about their health and care.
Transcarent is aligned with those who pay for healthcare and takes accountability for results – offering at-risk pricing models and transparent impact reporting to ensure incentives support a measurably better experience, better health, and lower costs.
At Transcarent, you will be part of a world-class team, supported by top tier investors like 7wireVentures and General Catalyst, and founded by a mission-driven team committed to transforming the health and care experience for all. In May 2024, we closed our Series D with $126 million, propelling our total funding to $450 million and fueling accelerated AI capabilities and strategic growth opportunities.
We are looking for teammates to join us in building our company, culture, and Member experience who:
- Put people first, and make decisions with the Member’s best interests in mind
- Are active learners, constantly looking to improve and grow
- Are driven by our mission to measurably improve health and care each day
- Bring the energy needed to transform health and care, and move and adapt rapidly
- Are laser focused on delivering results for Members, and proactively problem solving to get there
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
- Execute day-to-day internal operations of our SurgeryCare product, ensuring seamless member case placement through post-service claims collection and review
- 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
- Accurately assign CPT codes to patient cases, ensuring proper coding for diagnosis, procedures, and treatments
- Review post-service claims coding for accuracy, medical necessity and appropriateness of care to minimize billing issues, discrepancies, and delays
- Communicate effectively with internal operations and management teams to identify and resolve issues, escalations, and delays
- Develop and implement coding policies, guidelines, and standard operating procedures (SOPs) that comply with legal, ethical, and regulatory requirements (e.g., HIPAA, CMS guidelines)
What we’re looking for
- Bachelor’s degree in healthcare or a related field
- 5+ years related work experience in medical coding, healthcare operations, or revenue cycle management, experience with episodic bundles preferred
- Active medical coding certification required - Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Medical Coder (CMC), or equivalent
- Deep understanding of medical coding - CPTs, HCPCs, DRGs, ICD-10, etc.
- Experience with medical billing and claims auditing, as well as working with providers and carriers/TPAs
- Comfortable working independently and as part of a team, with minimal direct supervision
- Results-oriented – experience achieving daily metrics and adhering to internal turnaround times
- Excellent interpersonal and communication skills; willingness to speak up, ask questions, or request clarity when something is unclear
- Highly organized and detail-oriented; follows standard policies and procedures, but can adapt and problem-solve through non-standard situations or escalate when appropriate
- 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
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:
- Competitive medical, dental, and vision coverage
- Competitive 401(k) Plan with a generous company match
- Flexible Time Off/Paid Time Off, 12 paid holidays
- Protection Plans including Life Insurance, Disability Insurance, and Supplemental Insurance
- Mental Health and Wellness benefits
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.
