Healthcare Appeals & Grievances Coordinator

Metropolitan Jewish Health System, Inc.; New York (NY); Ibrido; USD 55.000 - 75.000; Tempo pieno

Descrizione del lavoro

Metropolitan Jewish Health System, Inc. seeks an A&G Coordinator to investigate and respond to member and provider appeals and grievances in line with Contract Benefits, CMS and DOH rules. You will determine service types, investigate, and document cases, ensuring timely completion and proper review.

The role requires strong written and verbal communication, attention to detail, and the ability to manage multiple tasks and meet deadlines in a fast-paced health plan environment.

Competenze

• Associates degree or equivalent preferred.
• 2 years prior related experience.
• Proficient in MS Word and Excel.
• Excellent written and verbal communication skills, attention to detail, ability to set priorities and meet deadlines, and manage multiple tasks.

Mansioni

• Investigate and respond to written or verbal appeals and grievances submitted by members and providers.
• Determine the appropriate type of service, appeal or grievance.
• Investigate and respond within time guidelines.
• Present cases for review and document all relevant information.

Conoscenze

Written communication

Verbal communication

Prioritization

Multitasking

Attention to detail

Formazione

Associates degree or equivalent preferred

Strumenti

MS Word

Excel

Descrizione del lavoro

Metropolitan Jewish Health System, Inc. seeks an A&G Coordinator to investigate and respond to member and provider appeals and grievances in line with Contract Benefits, CMS and DOH rules. You will determine service types, investigate, and document cases, ensuring timely completion and proper review.

The role requires strong written and verbal communication, attention to detail, and the ability to manage multiple tasks and meet deadlines in a fast-paced health plan environment.