Medical Coding Bundles Specialist

Who we are  

Transcarent is the One Place for health and care. We cut through the complexity, making it easy for people to access high-quality, affordable care. With a personalized app tailored for each Member, an on-demand care team, and a connected ecosystem of high-quality, in-person care and virtual point solutions, Transcarent eliminates the guesswork to confidently guide Members to the right level of care. We take accountability for results – offering at-risk pricing models and transparent impact reporting to align incentives towards 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. We closed on our Series C funding in January 2022, raising our total funding to $298 million and enabling us to respond to the demand for our offering.  

Transcarent is committed to growing and empowering a diverse and inclusive community within our company. We believe that a team with diverse lived experiences, working together will strengthen our organization, and our ability to deliver "not just better but different" experiences for our members.  

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 Medical Coding Bundles Specialist reports to the Care Experience Lead, Surgery Care and is responsible for defining, creating and managing episode bundles and supporting other coding and value- based payment strategies. The Value-Based Medical Coding Specialist should be passionate about the mission, vision, and value statements of Transcarent and be excited to learn about the cross-functional importance of coding to further our work! 

What you’ll do 

You will be responsible for defining, creating, standardizing and managing episode bundles for our Care Experiences which include orthopedics, spine, cardiac, bariatrics, cancer, gynecology vascular, gastroenterology, neurology, substance use disorder, inpatient psych, outpatient specialties and more.  You will collaborate with clinical and cross-functional teams to advance our existing episode bundles and to create new ones.  You will also collaborate with third party partners including health systems, providers and a TPA to facilitate management of the bundles and other value-based payment strategies.  You will also work with data analytics on strategies to identify complications, shared savings, and other opportunities in claims data.   

• Act a point of contact for any internal Medical coding needs to support member cases and provider contracting 
• Review and audit provider pricing benchmarks and claims 
• Support day-to-day clinical operations and case management teams with custom pricing benchmarks leveraging existing data, tools, and processes. 
• Define, create, refine, standardize and manage a portfolio of episode bundles across a variety of clinical areas and specialties 
• Define coding requirements for individual, outlier episodes of care 
• Function as the medical coding SME related to value-based payment strategies and claims data analytics 

What we’re looking for 

• Must hold active medical coding certification – CPC, CCS, CMC or equivalent 
• A minimum of 5 years related work experience in medical coding  
• A minimum of 2 years' experience in working with episodic bundles  
• Deep understanding of CPT, HCPCs, DRGs, ICD-10 
• Experience in billing and claims auditing, as well as, working with providers and carriers/TPAs 
• Extensive experience with commercial claims and Medicare claims payment (Surgery and Oncology preferred) 
• Interest in value-based payment models and experience preferred 
• Experience relating to Commercial claims data analytics preferred 
• Project management experience preferred 
• Ability to be flexible and embrace change while remaining highly organized 
• Excellent attention to detail and a self-starter 

Total Rewards 

Individual compensation packages are based on a few different factors unique to each candidate, including primary work locatio