Senior Appeals Coordinator II

Metropolitan Jewish Health System; New York (NY); On-site; USD 58,000 - 65,000; Full time

Benefits offered by this job

Tuition Reimbursement

Generous PTO

Medical/Dental/Vision coverage for you

Retirement plans (403(b) & Pension)

Flexible spending

PSLF eligibility

Job summary

Metropolitan Jewish Health System is seeking an Appeals and Grievances Coordinator to manage non-clinical aspects of member and provider appeals and grievances. You will ensure accurate intake, timely case processing, and regulatory adherence, coordinating with clinical and operational teams to support member advocacy.

The role emphasizes accurate case setup, triage, documentation tracking, and correspondence management within Elderplan Contract Benefits, CMS, and DOH guidelines, with a focus on

Qualifications

• Associates Degree required.
• BA/BS Degree preferred.
• Minimum 2 years A&G or Member Service experience required.
• Knowledge of Medicare or Medicaid.

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.
• Documents 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.
• Presents cases to the Appeals & Grievances File Review Team as needed.
• Successfully complies 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

Skills

A&G or Member Service experience

Medicare/Medicaid knowledge

Education

Associates Degree

BA/BS Degree preferred

Job description

Metropolitan Jewish Health System is seeking an Appeals and Grievances Coordinator to manage non-clinical aspects of member and provider appeals and grievances. You will ensure accurate intake, timely case processing, and regulatory adherence, coordinating with clinical and operational teams to support member advocacy.

The role emphasizes accurate case setup, triage, documentation tracking, and correspondence management within Elderplan Contract Benefits, CMS, and DOH guidelines, with a focus on