At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting Title Initial Review Pharmacy TechnicianJob Description Plays a key role in medical and pharmacy management initiatives critical to the company achieving revenue goals and operational objectives. Responsible for executing utilization management programs on behalf of health plan/payor customers, while utilizing additional clinical knowledge pertaining to a set list of managed medications across all health plans, with additional training for each medication and therapeutic class. Primary activities center on reviewing both prospective and retrospective requests for therapeutic appropriateness using sound clinical criteria. Responsible for making and receiving calls to and from physicians, patients, and pharmacies to gather additional clinical information to determine medication reimbursement. Recommendations will be based on an in-depth understanding of specific specialty medications and industry guidelines, on both pre- and post-service requests. Coordinates with operations, clinical, medical, reporting and other internal departments as needed. Responsibilities - Reviews pertinent patient information and checks appropriateness using clinical criteria. Makes approval recommendations on all services that meet clinical review criteria. Refers all cases not meeting clinical criteria to pharmacist clinical reviewer. - Practices and maintains the principles of utilization management by adhering to the company policies and procedures. Upholds clinical integrity of pharmaceutical solutions by participating in on-going training programs to ensure quality performance in compliance with applicable standards and regulations. Expert within the organization. - Conducts Program Integrity Audits including outreach and review of medical records to audit authenticity of provider response during Prior Authorization and reporting results to client. - Assists with the documentation and implementation of both written and verbal communications to physicians/prescribers and assists in the maintenance of the edits and data elements that support the edits. - Available for consultation in pharmacy related questions to resolve claims submission related to medication edits. - Contacts physicians/prescribers to obtain pertinent clinical history/information. Provides optimum customer service through professional/accurate communication while maintaining NCQA and health plan`s required timeframes. - Regularly reviews and monitors information on pended claims identified as outliers by internal and/or external analysis of pharmacy claims data. - Supports Intake call volume and order entry if necessary. - Determines eligibility for medication reimbursement based upon established clinical criteria and clinical knowledge and enters approvals or denials in the system. - Electronically documents both written and verbal communications with physicians, their staff, cardholders, and pharmacies. - Escalates medical exception requests to nurse, pharmacist or physician on the utilization review clinical team when further review is necessary. - Other duties as assigned. Minimum Qualifications - HS diploma or GED is required - 4 years of Pharmacy Experience - CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy Must be eligible to work in the United States without the need for work visa or residency sponsorship Additional Qualifications - Must have an active pharmacy technician licensure or registration in accordance with state requirements. - If state does not require an exam for licensure/registration, must possess both active pharmacy technician licensure or - registration in accordance with state requirements AND an active national certification (e.g., PTCB or ExCPT). - In states that do not require licensure or registration, must have an active national certification (e.g., PTCB or ExCPT). - Minimum of 2 years of pharmacy experience without a Bachelors degree OR 2 years of pharmacy experience with a - Bachelors degree in Science, Health, Medical or related field. - Specialty or retail pharmacy experience, previous reimbursement experience, and/or working in a health plan/health care setting. - Experience as Pharmacy Technician, Utilization Management or Customer Service in a high-volume, multi-functional call center environment. - Must be comfortable with using computers and the internet; basic skills with Microsoft office products and ability to quickly learn proprietary systems, typing. - Strong team orientation with respect for all members. - Excellent verbal and written communications skills. - People skills are essential that allow for the successful consultation with physicians, prescribers and pharmacists and for successful collaboration with company employees and external vendors who do not directly report to this position. - Analytic skills which can translate into practical and pragmatic recommendations. - In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques and medical terminology. Preferred Qualifications - Oncology pharmacy or other clinical pharmacy experience. - 4 years of pharmacy experience Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job. Potential pay for this position ranges from $23.08 - $37.02 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits). Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.   We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics LLC is a Tobacco-Free Workplace employer. Positions will be posted for a minimum of five consecutive workdays.

• Review clinical documentation and diagnostic results to extract data • Apply appropriate ICD-10 and PCS Diagnosis codes, along with CPT/HCPCS codes • Maintain a working knowledge of ICD-9-10 PCS and CPT coding principles • Assure all services documented in the patient’s chart are coded appropriately • Achieve and maintain 95% accuracy in coding and maintain high productivity standards • Seek proper documentation when services/diagnoses are not documented appropriately

Description BKG Enterprises is seeking Medical Management Specialist to join our team! This is a work-from home opportunity! - Call Center - Monday - Friday 8am-5pm -Training pay: $18.50/hr after training pay $19.25/hr -Medical, dental, and vision insurance offered -Supplemental insurace -80 hours of PTO after 90 days -10 paid holidays Responsible for providing non-clinical support to medical management operations calls, which includes handling the most complex file reviews and inquiries from members and providers. Primary duties may include but are not limited to: - Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review). - Conducts initial review of files to determine appropriate action required. - Maintains and updates tracking databases. - Prepares reports and documents all actions. - Responds to requests, calls or correspondence within scope. - Provides general program information to members and providers as requested. - May review and assist with cases. - May collaborate with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager. - Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information. - Acts as liaison between medical management operations and other internal departments to support ease of administration of medical benefits. Provides mentoring and work direction to lower-level associates. - Requirements - Requires a high school diploma and a minimum of 5 years administrative and customer service experience; or any combination of education and experience which would provide an equivalent background. Knowledge of managed care or Medicaid/Medicare concepts strongly preferred. - Position requires strong customer service/call center skills

Work Schedule: This is a full time, 1.0 FTE position. Shifts will be scheduled Monday – Friday. Hours may vary based on the operational needs of the department. This is a remote position. To be eligible to work remotely, you must be in an approved remote work state for UW Health. We’ve included a link below to view the full list of approved remote work states. Approved Remote Work States Listing Be part of something remarkable Advance your coding career at UW Health! We are seeking a Medical Coding Lead to: - Monitor coding operations with respect to workflows and regular reporting: evaluate workflows for maximum efficiencies and problem solve work queue issues when accounts/charges are not flowing properly, making recommendations as necessary. - Answer charging, coding, Epic or other software related questions from coders, CDI, clinical and Revenue Cycle staff. - Perform research, run various reporting and assist with general coding as needed and as requested. - Provide coding training within the Coding Department and perform research on coding issues. At UW Health, you will have: - An excellent benefits package, including health and dental insurance, paid time off, retirement plans, two-week paid parental leave and adoption assistance. - Options for a variety of schedules and shifts that offer flexibility and allow for work-life balance. - Access to great resources through the UW Health Employee Wellbeing Department that supports your emotional, financial, and physical well-being. - Tuition benefits eligibility - UW Health invests in your professional growth by helping pay for coursework associated with career advancement. - The opportunity to earn a referral bonus for referring friends, former colleagues or others to apply for open, posted positions. Qualifications - High School Diploma Required or - equivalent and Medical Coding Education Required Work Experience - 3 years progressive coding experience Required - More than five (5) years of coding experience in an academic medical center Preferred Licenses & Certifications - Certified Professional Coder (CPC) Upon Hire Required or - Certified Outpatient Coder (COC) Upon Hire Required or - Certified Inpatient Coder (CIC) Upon Hire Required or - Certified Coding Specialist (CCS) Upon Hire Required or - Certified Coding Specialist Physician-Based (CCS-P) Upon Hire Required or - Certified Coding Associate (CCA) Upon Hire Required - Registered Health Information Technician (RHIT) Preferred - Registered Health Information Administrator (RHIA) Preferred Our Commitment to Social Impact and Belonging UW Health is committed to fostering a workplace that creates belonging for everyone and is an Equal Employment Opportunity (EEO) employer. Our respect for people shines through patient care interactions and our daily work practices as we work to embrace the knowledge, unique perspectives and qualities each employee and faculty member brings to work each day. It is the policy of UW Health to provide equal opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Job Description UW Medical Foundation benefits