A&G Coordinator

About the role

Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are expanding services to meet the needs of our patients and members. In this non-clinical role, you’ll have the opportunity to make a positive impact on the quality of our health plan members' lives by investigating and responding to written or verbal appeals and grievances from members and providers.

Responsibilities

• Determine the appropriate type of service, appeal, or grievance in accordance with Contract Benefits and CMS and DOH regulations.
• Investigate appeals and grievances and respond appropriately within time guidelines.
• Present cases for review.
• Document all relevant information.

Requirements

• Associates degree or equivalent preferred.
• 2 years of prior related experience.
• Proficiency in MS Word and Excel.
• Excellent written and verbal communication skills.
• Strong attention to detail.
• Ability to set priorities, meet strict deadlines, and manage multiple tasks simultaneously.