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Fraud, Waste and Abuse Analyst
APWU Health Plan is seeking a Fraud, Waste and Abuse Analyst to join our Utilization Management Department. This position discovers, develops and implements analytics related to fraud, waste and abuse activities. The analyst will collaborate with business partners for the purpose of identifying and delivering robust reporting and analytics capabilities to drive improved business performance in the fraud, waste and abuse space.
RESPONSIBILITIES
- Assist in identifying, validating and recovering claim overpayments.
- Validate claims to ensure the accuracy of algorithms and that no refund has previously been posted.
- Identify new overpayment opportunities through review and research.
- Interpret and analyze data to accurately assess and demonstrate key insights into trends and opportunities.
- Research potential new ideas and follow algorithm development process.
- Provide feedback regarding inventory levels, algorithm effectiveness and new ideas and assist with Quality Review process.
- Handle personal and confidential information with a high degree of integrity.
- Other duties as assigned.
REQUIREMENTS
- Associate degree in accounting, business, healthcare or a related field.
- Equivalent work experience in a similar position may be substituted for educational requirement.
- Excellent computer skills to include Microsoft Excel, HealthCare FraudShield software suite, QNXT claims adjudication system, savvy internet research skills and Ad hoc query and reporting.
- Highly organized, motivated self-starter with strong analytical and problem solving skills.
- Excellent written and oral communication skills.
- Knowledge of medical terminology, CPT and ICD10 coding, analytical methodologies and insurance and claim operations.
We offer a competitive salary; health, dental, & vision insurance; 401(k); generous vacation leave; and tuition reimbursement. Please ensure all of the above requirements are clearly reflected in your resume or specifically addressed in your cover letter. Stated salary requirements (range is acceptable) are required for consideration. Experience in a Union environment preferred. No relocation assistance available. Must pass criminal records check and drug screening prior to employment.
EOE M/F/D/V; Drug-Free Employer
NOTE TO AGENCIES
We do not accept unsolicited resumes from third-party vendors. Only resumes received from contracted agencies/vendors will be considered. Unsolicited resumes sent to APWU Health Plan will not be recognized and such agency will have no recourse from APWU Health Plan.