• Support re-pricing and pre-payment processes to ensure accurate claim valuation, validation, and alignment with payer rules and clinical standards. • Review, evaluate, and investigate claims data, medical billing logic, and CPT coding to ensure billing accurately reflects the patient’s care. • Identify and correct mismatches between clinical documentation and billing submissions to prevent denials, errors, compliance risks, and potential fraud or abuse. • Ensure all codes accurately represent the services provided, avoiding both under- and over-billing. • Fraud, Waste, and Abuse Detection (FWA): Identify and investigate potential FWA claims • Conduct detailed reviews of itemized bills, medical records, and other claims data to validate coding accuracy and appropriateness of charges • Work with insurance companies and TPAs to clarify medical necessity, address coverage discrepancies, and resolve claim disputes. • Serve as a subject-matter expert on clinical and billing topics during audits, product reviews, and client implementations. • Collaborate with Growth and Data Science teams to design and build scalable tools and solutions that support new growth opportunities in these areas.

• Provide comprehensive diabetes, hypertension, hyperlipidemia and weight loss care, education, and support for patients through chat, phone, and video calls following internal protocols • Create thorough consults aligned with internal protocols for 9amHealth physicians • Collaborate with Patient Care Advocates to ensure patient success

• Run commercial calls with existing customers including renewals, upgrades, downgrades, expansions, and billing conversations • Do contract math live on customer calls • Draft and send contracts for existing customers • Own Stripe-related billing issues for existing accounts • Partner with CSMs on account health signals • Plant seeds for cross-sell and new products during renewal calls • Maintain accurate records of contract terms, renewal dates, and commercial commitments

• Take inbound calls answering member and provider questions regarding coverage, benefits, claims, and other plan inquiries • Work in a fast-paced and multitasking environment • Provide excellent customer service and satisfaction with a goal of first call resolution • Research and solve problems for escalated calls • Maintain records, track cases, and log events for assigned area of benefits services • Provide direction and leadership in daily work and workflow of a service center team • Work on special projects as assigned