A&G Coordinator II

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)
• Maintain timeliness standards for all assigned cases

Qualifications

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

Benefits

Tuition Reimbursement for all full and part-time staff
Generous paid time off, including your birthday!
Affordable and comprehensive medical, dental and vision coverage for employee and family members
Two retirement plans! 403(b) AND Employer Paid Pension
Flexible spending

Pay

$58,000.00 - $65,000.00 per year

Schedule

Regular Full-Time