New York Appeals Coordinator

Job Summary

Supporting the clinical team in a full-time remote capacity, the New York Appeals Coordinator will manage the timely and accurate processing of appeals and grievances, including case file preparation, documentation organization, and communication with providers and members.

Key responsibilities:

• Prepare cases for clinical review by gathering documentation and coordinating with members and providers
• Perform administrative tasks, including generating determination letters and completing data entry in the True Care system
• Act as a liaison between the Health Plan and stakeholders during the appeal process, ensuring compliance with state and federal regulations

Required qualifications:

• High School Diploma or GED
• Bachelor's degree preferred
• Knowledge of New York state and federal regulations related to appeals and grievances
• Proficiency in Microsoft Office
• Understanding of the claims payment process and related data systems