About Abby Care Making family care possible. At Abby Care, we are tackling one of the most important and unsolved challenges of our time: family caregiving. Over 50 million Americans are family caregivers for loved ones without pay, tools, or support. Our mission is clear and ambitious: to train and employ family caregivers so they can get paid for the care they already provide at home. Abby Care is building a tech-powered, family-first care platform to efficiently deliver care, improve health outcomes, and provide the best-in-class experience nationwide. We are rapidly expanding our mission and looking for passionate team members to join. Abby Care has partnered with leading insurance plans, healthcare providers, and community organizations. We’re supported by top, mission-driven VCs to empower families throughout the country. The Role The Medical Claims Payment Posting, Reconciliation & Reporting Specialist is responsible for accurately posting insurance payments, reconciling daily deposits, resolving payment discrepancies, and generating financial and operational reports. This role ensures the integrity of revenue cycle processes and supports the organization’s financial performance through precise payment management and analysis. Key Responsibilities: - Accurately post insurance claim payments, adjustments, and denials into the practice management or billing system. - Review and interpret Explanation of Benefits (EOBs), Electronic Remittance Advices (ERAs), and correspondence from payers. - Apply correct contractual adjustments and identify underpayments, overpayments, or missing payments. - Perform daily reconciliation of posted payments against bank statements and deposits. - Investigate discrepancies between posted amounts and actual payments; escalate unresolved variances as needed. - Maintain accurate logs of deposits, remittances, and reconciliation summaries. - Conduct monthly reconciliation for internal financial reporting requirements. - Process payment batches and reconcile payment uploads to bank deposits. - Identify claim denials, partial payments, or payer inconsistencies. - Communicate with billing team members or payers to resolve payment issues. - Track recurring denial trends and recommend corrective actions to improve clean-claim rates. - Produce daily, weekly, and monthly payment and reconciliation reports. - Generate operational reports such as payment trends, payer performance, denial summaries, and accounts receivable insights. - Provide analysis supporting month-end closing and financial reviews. - Assist leadership with customized reporting requests. - Ensure compliance with HIPAA, payer guidelines, and internal financial protocols. - Maintain accurate and organized documentation of payments, remittances, and reconciliation records. - Support audit requests by supplying detailed payment and reporting documentation. The Requirements: - High school diploma or equivalent; associate degree or business/healthcare coursework preferred. - 3-5 years of experience in medical billing, payment posting, or healthcare revenue cycle operations. - Proven experience working with EOBs, ERAs, CPT/ICD-10 codes, and insurance payer processes. - Strong experience in payment reconciliation and financial reporting. - Proficiency with billing systems (e.g., Epic, Athena, NextGen, eClinicalWorks, Kareo, etc.) and Excel/Google Sheets. (CollaborateMD experience is highly preferred). - Hands-on experience navigating multiple insurance portals. - Prior experience managing or supervising a team. - Background in accounting or finance is a strong plus. - Strong proficiency in billing platforms and revenue cycle systems. - Experience with Excel or Google Sheets for reporting and reconciliation. - Comfortable learning and working within multiple healthcare technology platforms. Our Values - Families First Redefining healthcare starts with how we treat the parents and children we serve. We go above and beyond for every family, building strong, lasting relationships. We continually ask ourselves, “Would we want this for our own families?” - Urgency with Precision Millions of families are waiting for care, and they cannot wait, therefore this is not your typical 9 to 5 job. We match their urgency with our own, delivering exceptional care without compromise. Here, speed and excellence go hand in hand. - Relentlessly Resourceful As an ambitious startup, we adapt quickly and make the most of limited time and resources. We solve challenges with creativity to deliver results without unnecessary complexity. - Purpose with Positivity We take our mission seriously while never losing sight of the people behind the work. Respect, kindness, memes, and coffee make us stronger as a team and better for the families we serve. - Driven to Redefine What’s Possible We are here to make healthcare better, which means asking hard questions, challenging outdated systems, and finding smarter, more compassionate ways to deliver care. Benefits: - Competitive compensation packages that reflect the value you bring. We reward our team for the impact of their work – full-time employees are eligible for an annual company performance bonus. - Comprehensive health coverage that works for you. We cover 90% of your premiums and 70% for your dependents, with multiple PPO plan options to choose from for medical, vision, dental, life, and short-term disability. - Generous paid time off. We provide policies that allow you to recharge along with 10 paid company holidays. - Team bonding. We love bringing our teams together. As a full-time employee, you’ll get to connect, collaborate, and have fun through team activities and our annual company retreat. - Financial savings benefits to support your future. We support your financial well-being with HSA contributions, optional FSA and commuter benefits, and full coverage of all 401(k) account fees (employer match not currently offered). - Paid parental leave to support your growing family. We provide paid leave, so you can focus on bonding and adjusting to life as your family grows. We are an equal opportunity employer and welcome applicants from all backgrounds, consistent with applicable laws. Employment is contingent upon successful completion of a background check, satisfactory references, and any required documentation.

Description Location: Remote - Work From Home Compensation: $17.50-$19.00/hr Schedule: Monday-Friday; 40 hours per week *Candidates must reside in one of the following states: Alaska, Arkansas, Arizona, Florida, Idaho, Maryland, Minnesota, Montana, North Dakota, Nebraska, New Mexico, Nevada, Oregon, Texas, or Washington. Ideal Option has been working on the front lines of the opioid epidemic since our first clinic opened in 2012. With more than 80 clinics across 9 states, we continuously strive to be the nation’s leading provider of low-barrier evidence-based treatment for opioid use disorder. We are looking for a Medical Coder to join our growing team and help us in our vision to give back lives, reunite families, and heal communities that are suffering from the devastating effects of substance use disorder. We value our patients and our employees! We treat our employees like we would want to be treated ourselves: with respect and compassion. Benefits: At Ideal Option, we offer our employees a competitive and comprehensive benefits program to recognize how important you are to the company. Current benefits include: • Medical, vision, and dental • Short-term and long-term disability options • Life insurance • Employee Assistance and Life Assistance programs • A 401K retirement program • Pet Insurance • Paid time off and paid holidays The Role: As a Medical Coder, you play a key role in performing accurate coding and billing services within the billing department. Additional responsibilities include: - Reviews documentation and assigns appropriate ICD-10, CPT and HCPCS codes. - Assigns appropriate primary diagnosis after deciding what was chiefly responsible for the encounter. - Assigns appropriate modifiers according to guidelines. This includes and isn’t limited to deciding when the modifiers are appropriate to add onto CPT codes. - Finalizes the appropriate data for accounts. This includes but isn’t limited to assigning dates of service and physician names to appropriate procedures that were performed during the encounter and finalizing the account when completed. - Clarifies documentation or diagnosis by communicating with the physician. This includes but isn’t limited to: - Decides clarity needed and sends query to the physician. - Follows up after the physician answers the question and assign appropriate codes. - Maintains knowledge of current billing rules and trends for billing types assigned by attending seminars, workshops and watching webinars. - Ensures weekly, monthly, and quarterly department goals are met. - Helps assist any of the billing department with their job functions which includes but isn’t limited to verifying patient eligibility and working to resolve denied claims. - Meets Ideal Options core values of efficiency and accuracy. - Coder will comply with all elements within HIPPA and the Privacy Act. - Makes recommendations to the Billing and Coding Manager for process and quality improvement. - Identifies revenue cycle issues via the coding/billing process. - Maintains knowledge of current coding rules and trends for coding types assigned by attending seminars, workshops and watching webinars. Our ideal candidate is: Professional with strong interpersonal skills and effective communication skills, verbal and written. You maintain good work habits and good attendance. You also can work independently and have great problem-solving skills. Requirements Minimum Requirements to be considered: - High School Diploma or GED. - A minimum of one-year experience with physician coding. - AAPC Credential: Minimum certification of a CPC, Or AHIMA certification, or in pursuit of certification. - Proficiency with Microsoft product suite and Internet.

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