Member Appeals & Grievances Specialist

MJHS; New York (NY); On-site; USD 45,000 - 65,000; Full time

Job summary

MJHS in New York, NY seeks an A&G Coordinator to investigate and respond to member and provider appeals and grievances under CMS and DOH rules. In a non-clinical role, you will help ensure timely decisions and accurate documentation.

You will determine the appropriate type of service or grievance, present cases for review, and maintain records. Candidates should have an Associate degree or equivalent, two years of related experience, and strong MS Word and Excel skills, plus excellent

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

• Determine the appropriate type of service, appeal or grievance.
• Investigate and respond within CMS and DOH regulations and time guidelines.
• Present cases for review and document all relevant information.

Skills

Attention to detail

Communication skills

Deadline-driven

Multitasking

Education

Associates degree or equivalent preferred

Tools

MS Word

MS Excel

Job description

MJHS in New York, NY seeks an A&G Coordinator to investigate and respond to member and provider appeals and grievances under CMS and DOH rules. In a non-clinical role, you will help ensure timely decisions and accurate documentation.

You will determine the appropriate type of service or grievance, present cases for review, and maintain records. Candidates should have an Associate degree or equivalent, two years of related experience, and strong MS Word and Excel skills, plus excellent