A&G Coordinator II

Metropolitan Jewish Health System • New York, NY

1d • $58,000 - $65,000

About The Position

The A&G Coordinator II manages non-clinical aspects of member and provider appeals and grievances, ensuring accurate intake, validation, timely processing, and compliance with federal, state, and internal policy requirements. The role handles case setup, triage, documentation tracking, letter drafting, correspondence management, and coordination with clinical and operational teams. It supports member advocacy by ensuring cases follow the appropriate workflow with accuracy, professionalism, and regulatory adherence.

Requirements

• Associate degree required.
• At least 2 years of A&G or Member Service experience required.
• Knowledge of Medicare or Medicaid.

Nice To Haves

• Bachelor of Arts or Bachelor of Science degree preferred.

Responsibilities

• Review newly created cases to confirm accurate classification or reassign them to the correct classification as necessary.
• Review case history and identify additional information that may be required for an investigation.
• Respond promptly to written and verbal appeals and grievances from members and providers in accordance with Elderplan Contract Benefits, CMS, and DOH regulations.
• Document relevant information in the designated areas of the Appeals and Grievances system during the determination process.
• Manage assigned caseloads in accordance with regulatory requirements and company policy.
• Present cases to the Appeals & Grievances File Review Team as needed.
• Maintain at least 95% accuracy in audited case files during monitoring and auditing activities.
• Meet or exceed timeliness standards for assigned cases.

Benefits

• Tuition reimbursement for full-time and part-time staff.
• Generous paid time off, including a birthday benefit.
• Medical, dental, and vision coverage for employees and family members.
• 403(b) retirement plan and employer-paid pension.
• Flexible spending.
• The organization is a qualified employer under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF).
• Career development and opportunities for advancement.
• Work-life balance.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree