Care Operations Specialist

Remote Jobs; Brasil; Teletrabalho; USD 60.000 - 70.000; Tempo integral

Resumo da oferta

A leading health services company is seeking a Care Operations Specialist to manage operational processes for SurgeryCare. This remote role requires expertise in medical coding along with strong communication skills. Ideal candidates will have a proven track record in healthcare operations and be detail-oriented. Competitive salary range is available, along with comprehensive benefits.

Serviços

Competitive medical, dental, and vision coverage

401(k) Plan with company match

Flexible Time Off

Mental Health and Wellness benefits

Qualificações

• Required medical coding experience, especially in outpatient and oncology.
• Must hold a relevant coding certification (CPC, CCS, CMC, etc.).
• 5+ years in medical coding or healthcare operations required.

Responsabilidades

• Manage the operational aspects of SurgeryCare solutions.
• Ensure accurate coding for patient cases.
• Communicate with care support and internal teams to resolve issues.

Conhecimentos

Medical Coding experience

Interpersonal communication

Attention to detail

Results-oriented mindset

Formação académica

Bachelor's degree in healthcare or related field

Active medical coding certification

Descrição da oferta de emprego

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:

• 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

• Medical Coding experience required, with preference for surgical outpatient and oncology coding experience
• 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.
• 5+ years related work experience in medical coding, healthcare operations, or revenue cycle management, experience with episodic bundles preferred
• Bachelor's degree in healthcare or a related field
• 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

At Transcarent/Accolade, we are committed to compensation practices that are fair, competitive, and aligned with our mission to support every person's ability to thrive - at work and in life. The final base pay offered within the posted range is determined based on a candidate's job-related knowledge, skills, and experience, as well as internal equity and market competitiveness relative to geographic location. In the United States, we use three geographic pay zones to help guide equitable and market-aligned compensation decisions. Depending on the role, offers may also include additional forms of compensation such as short-term and long-term incentives (bonuses, equity, etc.) alongside a comprehensive benefits package that supports your physical, emotional, and financial well-being.

As a remote position, the salary range for this role is:

$60,000-$70,000 USD

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.