Medical Coding Bundles Specialist - Contract

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 Medical Coding Bundles Specialist - Contract 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! 

In this role... 

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.   

This is a 2-month contract, remote position. 

Essential Duties and Responsibilities include the following. Other duties may be assigned.  

• 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 

Qualifications: 

• 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 

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

$25.00 - $30.00/hour 

Total