• Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards • Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal • Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQA standards • Communicates with members, providers, facilities, and other departments regarding appeals requests • Generates appropriate appeals resolution communication and reporting for the member and provider in accordance with company policies, State, Federal and NCQA standards • Works with leadership to increase consistency, efficiency, and appropriateness of responses of all appeals requests • Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices • Performs other duties as assigned • Complies with all policies and standards

• Conduct online “Video Visits” with health plan members • Provide 40 hours of availability weekly, consistently providing 320+ capacity units per month • Execute a strong visit completion rate, consistently pacing 220+ completed visits per month • Maintain training, affiliation, and compliance with Video Visit requirements (regular training required)

• Conduct online “Video Visits” with health plan members, working in a private space with adequate internet connection • Provide 40 hours of availability weekly, consistently providing 320+ capacity units per month • Execute a strong visit completion rate, consistently pacing 220+ completed visits per month • Maintain training, affiliation, and compliance with Video Visit requirements (regular training required)

• Deliver proactive coding education through newsletters, scorecards, and presentations • Lead onboarding and compliance training for all employed Physicians/APPs • Provide individualized documentation feedback by reviewing new clinician records and conducting spot checks • Serve as the primary contact for coding inquiries • Monitor Epic work queues to ensure timely and accurate charge submissions • Collaborate across departments to enhance documentation practices and system optimization • Participate in specialty and department meetings • Refine Epic documentation tools to improve efficiency and accuracy • Ensure compliance with regulatory standards