MJHS
Req #: 3385
Job ID: 14838 Job Location: New York, NY Zip Code: 10041 Category:
Office and Administrative Support Agency:
Elderplan Status:
Regular Full-Time Office:
Hybrid Salary:
$45,000.00 - $50,000.00 per year The evolving landscape of affordable healthcare offers new opportunities, and at Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, we are committed to expanding services that meet the needs of our members. These exceptional health plans are designed to empower individuals to maintain their independence and quality of life. As a key member of the A&G Fair Hearing team, the A&G Fair Hearing Coordinator will serve as a critical liaison connecting the Plan, OTDA, IAHO, members, and delegated vendors. Your role will be essential in coordinating telephonic and in-person fair hearings. This position requires top-notch communication, organizational, and time management skills to ensure timely collection of documentation, seamless communication among stakeholders, effective scheduling of hearings, and diligent management of documentation regarding fair hearing statuses and outcomes. The MJHS Difference At MJHS, we are more than just a workplace; we are a compassionate community dedicated to excellence and high-quality, personalized healthcare services. We encourage collaboration, celebrate our successes, and uphold fairness for all. We recognize our contributions with comprehensive compensation and benefits, career advancement opportunities, and support for a healthy work-life balance. Benefits include: Tuition Reimbursement for all full-time and part-time staff Generous paid time off, including your birthday! Affordable medical, dental, and vision coverage for you and your family Two retirement plans: 403(b) and Employer Paid Pension Flexible spending accounts And more! MJHS companies qualify under the Federal Government's Paid Student Loan Forgiveness Program (PSLF). Responsibilities: Act as a liaison providing timely coordination for external reviews, including NYS Fair Hearing and NYS DFS External Appeal. Receive and process Fair Hearing requests/documentation. Maintain accurate case tracking and outcome data through timely entry into appeals and grievance software. Perform accurate and timely data entry in accordance with departmental workflows. Identify, triage, categorize, and route all documents received by the Appeals & Grievances Department. Process AOR and WOL requests in alignment with SDOH and CMS regulations. Participate in scheduled team meetings. Qualifications: High School Diploma required; Associate or Bachelor's degree preferred. Two years of prior managed care experience required; healthcare setting experience preferred. Familiarity with appeals and/or fair hearings. Proficient with telephone, fax, email, scanner, and Microsoft Office Suite. Excellent written and oral communication skills. Strong analytical abilities and empathetic understanding. Ability to maintain confidentiality and work within a team framework. Strong customer service skills and prioritization abilities. Capacity to assess member needs and recommend alternative care levels. Ability to foster collegial relationships and work in an interdisciplinary team environment.
Job ID: 14838 Job Location: New York, NY Zip Code: 10041 Category:
Office and Administrative Support Agency:
Elderplan Status:
Regular Full-Time Office:
Hybrid Salary:
$45,000.00 - $50,000.00 per year The evolving landscape of affordable healthcare offers new opportunities, and at Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, we are committed to expanding services that meet the needs of our members. These exceptional health plans are designed to empower individuals to maintain their independence and quality of life. As a key member of the A&G Fair Hearing team, the A&G Fair Hearing Coordinator will serve as a critical liaison connecting the Plan, OTDA, IAHO, members, and delegated vendors. Your role will be essential in coordinating telephonic and in-person fair hearings. This position requires top-notch communication, organizational, and time management skills to ensure timely collection of documentation, seamless communication among stakeholders, effective scheduling of hearings, and diligent management of documentation regarding fair hearing statuses and outcomes. The MJHS Difference At MJHS, we are more than just a workplace; we are a compassionate community dedicated to excellence and high-quality, personalized healthcare services. We encourage collaboration, celebrate our successes, and uphold fairness for all. We recognize our contributions with comprehensive compensation and benefits, career advancement opportunities, and support for a healthy work-life balance. Benefits include: Tuition Reimbursement for all full-time and part-time staff Generous paid time off, including your birthday! Affordable medical, dental, and vision coverage for you and your family Two retirement plans: 403(b) and Employer Paid Pension Flexible spending accounts And more! MJHS companies qualify under the Federal Government's Paid Student Loan Forgiveness Program (PSLF). Responsibilities: Act as a liaison providing timely coordination for external reviews, including NYS Fair Hearing and NYS DFS External Appeal. Receive and process Fair Hearing requests/documentation. Maintain accurate case tracking and outcome data through timely entry into appeals and grievance software. Perform accurate and timely data entry in accordance with departmental workflows. Identify, triage, categorize, and route all documents received by the Appeals & Grievances Department. Process AOR and WOL requests in alignment with SDOH and CMS regulations. Participate in scheduled team meetings. Qualifications: High School Diploma required; Associate or Bachelor's degree preferred. Two years of prior managed care experience required; healthcare setting experience preferred. Familiarity with appeals and/or fair hearings. Proficient with telephone, fax, email, scanner, and Microsoft Office Suite. Excellent written and oral communication skills. Strong analytical abilities and empathetic understanding. Ability to maintain confidentiality and work within a team framework. Strong customer service skills and prioritization abilities. Capacity to assess member needs and recommend alternative care levels. Ability to foster collegial relationships and work in an interdisciplinary team environment.