A&G Coordinator

MJHS; New York (NY); On-site; USD 65,000 - 75,000; Full time

Job summary

MJHS seeks an A&G Coordinator to investigate and respond to member and provider appeals and grievances in line with Contract Benefits, CMS and DOH regulations. You will determine service type, investigate cases, and ensure timely, well-documented responses.

The role requires strong written and verbal communication, attention to detail, and the ability to manage multiple tasks while meeting deadlines. Proficiency in Word and Excel is essential.

Qualifications

• Associates degree or equivalent preferred.
• 2 years prior related experience.
• Must be proficient in MS Word and Excel.
• Excellent written and verbal communication skills, attention to detail, ability to set priorities appropriately and meet strict deadlines and the ability to manage multiple tasks simultaneously is required.

Responsibilities

• Investigate and respond to written or verbal appeals and grievances submitted by members and providers in accordance with Contract Benefits and CMS and DOH regulations.
• Determine the appropriate type of service, appeal or grievance.
• Investigate and respond appropriately and within time guidelines.
• Present cases for review and document all relevant information.

Skills

Strong written & verbal communication

Attention to detail

Prioritization & time management

Multitasking

Education

Associate degree or equivalent

Tools

MS Word

Excel

Job description

Come lead with us at New York, NY

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms. Even in a non-clinical role, Elderplan employees have an opportunity to make a positive impact on the quality of our health plan members' lives.

The A&G Coordinator will investigate and respond to written or verbal appeals and grievances submitted by members and providers in accordance with Contract Benefits and CMS and DOH regulations. Key responsibilities include determining the appropriate type of service, appeal or grievance, investigating and responding appropriately and within time guidelines, presenting cases for review and documenting all relevant information.

• Associates degree or equivalent preferred.
• 2 years prior related experience.
• Must be proficient in MS Word and Excel.
• Excellent written and verbal communication skills, attention to detail, ability to set priorities appropriately and meet strict deadlines and the ability to manage multiple tasks simultaneously is required.