A&G Coordinator II

MJHS; United States; On-site; USD 50,000 - 70,000; Full time

Benefits offered by this job

Tuition Reimbursement

Generous paid time off

Comprehensive medical coverage

403(b) and Employer Paid Pension

Flexible spending

Student Loan Forgiveness Program eligibility

Job summary

MJHS is seeking a dedicated coordinator to manage all non-clinical aspects of member and provider appeals. This role involves case processing, documentation, and coordination with clinical teams to ensure compliance with regulations.

Ideal candidates will have at least 2 years of appeals and grievances experience, knowledge of Medicare/Medicaid, and a diploma. The position offers comprehensive benefits and opportunities for professional growth.

Qualifications

• Minimum 2 years of Appeals and Grievances or Member Service experience required.
• Knowledge of Medicare or Medicaid is necessary.

Responsibilities

• Manage and process appeals and grievances with accuracy and compliance.
• Review cases and confirm proper classifications as necessary.
• Respond to appeals in a timely manner following regulatory guidelines.
• Document all relevant information accurately in the A/G system.

Skills

Member advocacy

Case management

Regulatory compliance

Documentation tracking

Education

Diploma

Job description

Position Summary

Manages all non-clinical aspects of member and provider appeals and grievances to ensure accurate intake, validation, timely case processing, and compliance with federal, state, and internal policy requirements. This role performs case setup, triage, documentation tracking, letter drafting, correspondence management, and coordination with clinical and operational teams. The coordinator supports member advocacy by ensuring each case proceeds through the proper workflow with a high degree of accuracy, professionalism, and regulatory adherence.

Benefits

• Tuition Reimbursement for all full and part-time staff
• Generous paid time off, including your birthday!
• Affordable and comprehensive medical, dental and vision coverage for employee and family members
• Two retirement plans: 403(b) and Employer Paid Pension
• Flexible spending
• MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)

Responsibilities

• Review newly created cases to confirm accurate classification or reassignment to correct classification as necessary.
• Review history and identify additional information that may be required as part of the investigation.
• Respond in a timely manner to written and/or verbal appeals and grievances submitted by members and providers in accordance with Elderplan Contract Benefits, CMS, and DOH regulations.
• Document all relevant information in the Appeals and Grievances determination process within the appropriate designated areas of the A/G system.
• Maintain regulatory compliance and company policy through thoughtful management of assigned caseload.
• Present cases to the Appeals & Grievances File Review Team as needed.
• Successfully comply with the accuracy of case files in key performance indicators during monitoring and auditing activities (95% of audited case files).
• Meet or exceed timeliness standards for all assigned cases.

Qualifications

• Diploma
• Minimum 2 years A&G or Member Service experience required
• Knowledge of Medicare or Medicaid