Senior A&G Coordinator

MJHS; New York (NY); On-site; USD 60,000 - 80,000; Full time

Job summary

MJHS is seeking an A&G Analyst to support the A&G Department in New York, NY. The A&G Analyst will be responsible for preparing and submitting External Appeals and QIO case files, ensuring compliance with State and Federal Regulatory Requirements.

Qualified candidates will have a BA/BS degree and 3-4 years of relevant experience, ideally in Managed Care. Excellent communication and analytical abilities, along with proficiency in Microsoft Office tools, are essential for this role.

Qualifications

• 3-4 years prior related experience preferably in Managed Care or Health Care related organizations.
• Telephone, Fax, Email, Scanner proficiency required.
• Capacity to learn other programs as assigned.

Responsibilities

• Prepare and submit External Appeals and QIO case files.
• Complete all quarterly DOH, CMS, and departmental reports.
• Assist A&G Fair Hearing Coordinator and Senior Specialists as needed.

Skills

Excellent written and oral communication skills

Good analytical abilities

Good customer service skills

Education

BA/BS degree or equivalent

Tools

Microsoft Word

Excel

Powerpoint

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.

As a support to the A&G Department, the A&G Analyst is responsible for the preparation, communication, and submission of External Appeals and QIO case files to the Department and Financial Services (DFS) and the Quality Improvement Organization (QIO). Complete all quarterly DOH, CMS, and departmental reports. Serve as a backup for the A&G Fair Hearing Coordinator and the A&G Senior Specialists and other A&G staff as needed. Assist with VAM upgrades, and training as needed. The position requires excellent communication, time management, and proficiency in multiple systems to facilitate the timely gathering of documentation, communication, and collaboration between responsible parties to ensure compliance with all State and Federal Regulatory Requirements.

• BA/BS degree or equivalent, relevant experience required.
• 3-4 years prior related experience is requirpreferablybly in Managed Care or Health Care related organizations.
• Telephone, Fax, Email, Scanner, Microsoft Word, Excel, Powerpoint, capacity to learn other programs as assigned.
• Excellent written and oral communication skills.
• Good analytical abilities.
• Ability to be empathetic and understanding.
• Ability to handle confidential aspects of the position.
• Ability to work closely with different professionals as part of an interdisciplinary healthcare team.
• Good customer service skills.
• Ability to set priorities.
• Ability to work independently while recognizing issues having a departmental or organizational impact.
• Ability to maintain collegial relationships and work in an interdisciplinary team environment.