A&G Coordinator II

MJHS • New York, NY

11d

About The Position

Manages the non-clinical aspects of member and provider appeals and grievances, ensuring accurate intake, validation, timely case processing, and compliance with federal, state, and internal policy requirements. The role supports case setup, triage, documentation tracking, letter drafting, correspondence management, and coordination with clinical and operational teams. It helps ensure 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

• BA/BS 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 needed for the investigation.
• Respond in a timely manner to written and verbal appeals and grievances submitted by members and providers, in accordance with Elderplan Contract Benefits and CMS and DOH regulations.
• Document relevant information in the designated areas of the Appeals and Grievances system during the determination process.
• Manage assigned caseloads to maintain regulatory compliance and adherence to 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 day off.
• Medical, dental, and vision coverage for employees and family members.
• Two retirement plans: 403(b) and an employer-paid pension.
• Flexible spending accounts.
• Employer qualification under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF).
• Career development and advancement opportunities.
• Work-life balance.

What This Job Offers

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