Care Operations Specialist - Remote

Overview

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.

In Short

• Execute day-to-day internal operations of our SurgeryCare product.
• Collaborate closely with our Care Support Services team.
• Accurately assign CPT codes to patient cases.
• Review post-service claims coding for accuracy.
• Communicate effectively with internal operations and management teams.
• Develop and implement coding policies and guidelines.

Requirements

• Bachelor’s degree in healthcare or a related field.
• 5+ years related work experience in medical coding or healthcare operations.
• Active medical coding certification required.
• Deep understanding of medical coding - CPTs, HCPCs, DRGs, ICD-10.
• Experience with medical billing and claims auditing.
• Excellent interpersonal and communication skills.

Benefits

• 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 and Disability Insurance.
• Mental Health and Wellness benefits.