Role Description The Quality Improvement Specialist facilitates the establishment of QI activities and methods of measurement that are prioritized to organizational priorities. This position collaborates with various functional areas to understand and alleviate obstacles as needed and monitors for successful performance via the Quality Improvement Committee. This position is eligible for remote work, but quarterly travel will be required to Avalon's corporate office located in Tampa, Florida. Essential Functions and Responsibilities: - Manage and monitor quality auditing that may be undertaken by Avalon, including receipt and analysis of claims data, development of improvement recommendations, implementation of plan, and evaluation for desired result. - Perform quality auditing based on data analytics reporting on claims data with a keen eye for inconsistent results. - Complete work on a monthly and quarterly cadence to deliver quality auditing findings and recommendations. - Collaborate with Medical Policy, Configuration, Policy and Enforcement, Coding and Translation departments to accurately reflect medical and claims payment policies. - Monitor required QI Work Plan metric trends, identify variation, convene functional area or cross-functional teams as needed to conduct root cause analysis and institute meaningful action to achieve defined performance goals. - Establish annual QI Work Plan which defines quality improvement priorities from both an activity and metric standpoint; update to insert data and information as received; conduct annual evaluation. - Set agenda/create Quality Improvement Committee meeting materials to drive desired meeting outcomes and ensure proper recording of committee activities. - Perform various department functions and processes, such as those associated with client health plan delegation oversight, internal auditing functions, and annual QI/UM operational policy review and revision. - Other duties as assigned by Manager. Qualifications - 3-5 years of Health Care Quality Improvement experience in a managed care or health care services vendor relationship setting. - Bachelor’s degree or equivalent experience. - Certified Billing and Coder: CPC (Certified Professional Coder) and/or CCS (Certified Coder Specialist), CPMA (Certified Professional Medical Auditor). - Working knowledge of Medical Policies and medical coding. - Strong knowledge of Health Plan claims, medical billing, and medical coding. - Expert proficiency in written and oral communication skills required. - Expert proficiency in computer skills including Microsoft Office Suite products (Excel a must). - Strong understanding of health insurance claims and terminology. - Strong communication, delivery, and presentation skills. - Strong understanding of laboratory billing and reimbursement practices. - High attention to detail and documentation. - Clinical experience with a background of ICD-10, CPT, and HCPCS coding principles. - Exceptional interpersonal skills with demonstrated ability to work independently as well as with a team. - Strong organizational skills. Requirements - Experience with Centers for Medicare & Medicaid Services (CMS) and industry standard billing, compliance, and reimbursement methodologies. - Lab/Genetic test experience/familiarity. - Familiarity with commercial payor medical policies. - Knowledge of and experience with laboratory medical coding rules and regulations, compliance, reimbursement, bundling issues. - Experience with data analysis tools (SQL, PowerBI, JIRA). - Certification in Healthcare Quality. - Background in Biology, chemistry, medicine, nursing.

Job Description Summary Delivers basic technical, administrative, or operative Pharmacy tasks. Assists pharmacists in filling orders and preparing labels. Obtains new prescriptions and prescription refill information from customers. Tracks utilization/inventory and may provide standardized summaries and reports. Understands simple instructions and procedures. Performs Pharmacy Technician duties under direct instruction and close supervision. Work is allocated on a day-to-day or task-by-task basis with clear instructions. Entry point into professional roles. - Job Description As a PACE Pharmacy Technician, you will be assisting patients in receiving needed medications to help manage rare and/or chronic diseases. You’ll be empowered to engage patients, insurance companies, and multiple departments to process orders and ensure timely shipment of medications. This role is very detail oriented, and you’ll spend the majority of your day working on our computer system. Here’s a little more on how you’ll make a difference: - Accurately enter prescriptions into our system. Use the knowledge you gain from training, your problem-solving skills and support from your team to accurately enter patient prescriptions. - You’ll ensure that the medication prescription is accurately entered so it can be evaluated under insurance coverage and dispensed correctly. - Interact directly with healthcare providers. You’ll research issues on with pharmacist and doctors’ office and provide guidance to our patients about medication coverage. - Juggle multiple tasks without sacrificing attention to detail. You will be busy handling multiple requests at any given time as well as documenting information in our computer system. What you need to do the job: - High School Diploma, or GED required. - Minimum of six months related experience. - Valid Pharmacy Technician license/certification/registration as required by state laws. - Pharmacy Technician Certification preferred. - Microsoft Office proficiency and data entry skills - RxHome experience a plus - Basic math skills (addition/subtraction/multiplication) - Strong attention to detail, accuracy and quality - Excellent verbal and written communication skills Why Join Us? Health coverage effective day 1 (including medical, dental, vision) Holiday, PTO and OT pay 401K with company match Tuition reimbursement Fun, friendly and unique culture – bring your whole self to work every day! Growth and advancement potential Work Schedule: recruiting for the following Monday through Friday shifts: - 7 AM to 4 PM CT - 8 AM to 5 PM CT - 9 AM to 6 PM CT - 10 AM to 7 PM CT If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

• Responsible for timely and accurate client record maintenance • Supports client billing and remittance • Researches and resolves questions, complaints, and grievances • Ensures timely delivery of billing cycled invoices to clients • Prepares quarterly and monthly reconciliations as required

• Reviews inpatient clinical documentation, procedural information, and diagnostic results to apply ICD-10-CM and PCS codes • Accurately assigns ICD-10-CM and ICD-10-PCS codes to conditions and procedures • Applies Official Coding Guidelines and maintains quality and productivity standards • Works collaboratively with providers and departments to enhance coding, documentation, and quality reporting