Grow your career at APWU Health Plan
Data and Reporting Analyst
The APWU Health Plan, a non-profit organization located in Elkridge, MD, is seeking a Data and Reporting Analyst to join our Compliance Department.
The Data and Reporting Analyst is responsible for supporting the APWU Health Plan compliance duties to comply with applicable laws, regulations and accreditation standards.
PRIMARY ACCOUNTABILITIES:
- Collect and analyze data and records as needed for ongoing reviews and reports.
- Participate in meetings with staff and vendors.
- Conduct activities required to prepare for audits.
- Coordinate the policy review process for accreditation and quality performance measurements.
- Compile the meeting materials and draft the meeting minutes for the Quality Improvement Committee.
- Perform other duties as assigned.
QUALIFICATIONS:
- Bachelor degree in Information Technology, Statistics and Analytics, Business Administration or a related field.
- A minimum of 2-3 years’ in developing analytical reports and project management is preferred.
- Knowledge of Health Equity and HEDIS is desired.
- Ability to prioritize and manage multiple projects in accordance with the priorities set by the Compliance Department leadership.
- Proven track record of effectively and productively working with varied levels of personnel including with external vendors and business organizations both individually and in a group setting.
- Strong communication skills are required. The incumbent must demonstrate skillful communication verbally and in writing to successfully interact with internal and external personnel with different levels of responsibility.
- Demonstrated proficiency with Microsoft Office 365 including Excel, PowerPoint, Outlook, SharePoint and Word.
To apply
- All stated requirements must be 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
Staff Accountant II
The APWU Health Plan, a non-profit organization located in Elkridge, MD, is seeking a Staff Accountant II to join our Finance Department.
The Staff Accountant II is responsible for assisting in ensuring compliance with Generally Accepted Accounting Principles (GAAP) and Government policies for the Federal plan, conversion plan, and to manage the accounting and financial reporting of the pension, incentive and compensation plans.
PRIMARY ACCOUNTABILITIES:
- Monitor accounting policies, procedures and practices for compliance with applicable laws, Generally Accepted Accounting Principles and changes in legislative measures.
- Manage the accounting and financial reporting for the Employee Staff Pension Plan, Management Staff Pension Plan, Health and Welfare Trust Life Insurance Plan and Health Insurance Plan.
- Prepare journal entries related to the Federal Plan, Defined, Management & Employees’ Pension Plans, Post-Retirement Benefit Plans, Dental and Vision Benefit Plans.
- Prepare reconciliations for the Federal, and Pension Plans, and the Health and Welfare Trust.
- Complete monthly PNC Visa company credit card transaction and journal entry support timely and accurately.
- Administer plan personnel policies/CBA accurately and equitably.
- Approve Finance Department time off requests/weekly timecards for Finance Bargaining Unit Employees
- Operate within the unit budget.
- Supervise, motivate and counsel assigned staff.
- Complete payroll and all payroll related tasks accurately and timely.
- Update standards and unit procedures on a timely basis.
- Complete assignments in a timely manner.
- Perform other duties as assigned.
QUALIFICATIONS:
- BS Degree in Accounting or Finance or equivalent combination of Accounting coursework and experience
- Minimum one to three years of experience in audit, accounting, or in a governmental accounting position.
- Working knowledge of the Federal Acquisition Regulations (FARS) and governmental accounting experience desirable.
- Must be capable of obtaining/maintaining government clearance through OPM
- Excellent analytical, time-management, and organizational skills
- Strong verbal and written communication skills
- Proficient in Microsoft Office Products; ability to learn new software programs
- Understanding of IRS Publication 15 – Circular E and the related supplemental Publication 15-A, as well as Generally Accepted Accounting Principles.
- Working knowledge of payroll processing, and state and federal payroll reporting requirements.
Prior supervisory experience preferred.
To apply
- All stated requirements must be 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
IT Technical Analyst
The APWU Health Plan, a non-profit organization located in Elkridge, MD, is seeking an IT Technical Analyst to join our Applications Development Department.
The IT Technical Analyst has the principal responsibility for facilitating the creation, implementation, maintenance and optimization of the various Information Technology (IT) and non-IT related processes within the plan
Primary Accountabilities:
- Review and document current processes and workflows and collaborate with users in identifying, defining, and documenting process improvement options and alternatives, as directed by business needs.
- Analyze and recommend test scenarios to assist testing team with scenario building and validation.
- Conduct system impact analysis, in relation to operational requirements and report finding, and where appropriate, propose changes.
- Work proactively with designated stakeholders and teams to collaborate with vendors and internal business users to analyze information needs and documentation/artifacts needed.
- Translate requirements, of any kind, into functional and/or technical specifications as needed. Participate in requirement reviews with appropriate project team. Create presentations for review and approval by stakeholders for requirements, design specifications, functional requirements and prototypes.
- Identify required information fields and, in conjunction with the Data Objects team and or other Application Development team members, assist with the design and maintenance of a data dictionary.
- Create and maintain documented workflows and data diagrams for technical projects, and present the documentation to stakeholders and business owners.
- Coordinate with Applications Development Manager and Team Leads in conjunction with the Project Manager, assure priority of new work.
- Work with external vendors to escalate support issues to completion, scope business functional enhancement projects and validate recommended solutions to the organization.
- Complete other duties as assigned.
Qualifications:
- B.S. degree in Business, Economics, Public Health or Computer Science preferred, or equivalent experience.
- Minimum 3 years of experience in business analysis, requirements definition and deployment of business requirements to information systems.
- Thorough understanding of all aspects of claims processing systems – including (but not limited to) claim adjudication, membership and enrollment, eligibility, configuration and benefits, authorizations and payment.
- Must have Health Care background, preferably with knowledge of Health Plan operations.
- Excellent technical, analytical, and communication skills.
- Knowledge in SQL, Microsoft Visio and other Office tools, relational databases, application life cycle and ticketing systems.
- Must be able to construct and execute SQL queries for data, technical and quality analysis.
- Must possess good verbal and written communication skills; and, have the ability to render and write business requirements as technical documentation and business decision documentation.
- Proficiency in requirements gathering – effectively translating business needs as expressed by users into workable specs, estimating time\duration to complete and implement the solution.
- Experience with developing traceability matrix, to be used in software development and testing, is a plus.
To apply
- All stated requirements must be 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
Fraud Investigator
The APWU Health Plan, a non-profit organization located in Elkridge, MD, is seeking a Fraud Investigator to join our Utilization Management Department.
The Fraud Investigator is responsible for assisting in the special investigations operation and maintenance of a cost-effective fraud and abuse program through internal resources and assistance from outside vendors.
Primary Accountabilities:
- Research and analyze data for insurance fraud while applying appropriate investigative techniques.
- Investigate and handle internal and external fraud and abuse activities.
- Identify, prepare and track potential OIG notifications and correspondence.
- Conduct interviews and process vendor claims/case investigations.
- Contribute ideas for developing system edits and programs to detect fraudulent billing practices on a proactive basis.
- Track fraud and abuse inventory and savings reports for internal and external reports.
- Update and maintain internal, OIG and Vendor Fraud Waste and Abuse data tracking reports as directed.
- Responsible for standing in for the lead investigator when needed and performing other duties as assigned.
- Other duties as assigned.
Qualifications:
- Bachelor’s degree or equivalent work experience.
- A minimum of 5 years of experience in healthcare fraud, analytics, medical coding, and the operations of special investigative units (SIU)
- One of the following Certifications preferred:
- Accredited Healthcare Fraud Investigator (AHFI)
- Certified Fraud Investigator
- Medical Auditing or Clinical Coding Certifications such as CPC, CEMA, or CPMA
- Experience with fraud and abuse software and ability to data mine claims system data.
- Ability to define data and information needs; compile, analyze and interpret data relative to healthcare utilization.
- Knowledge of medical terminology, CPT and ICD10 coding, investigative techniques, analytical methodologies, and insurance and claim operations.
- Multi-disciplinary project management skills.
- Highly organized, motivated self-starter with strong analytical and problem solving skills.
- Excellent computer skills to include Microsoft Office, Healthcare Fraud Shield software suite, QNXT software suite, savvy internet research skills and Ad hoc query and reporting.
- Excellent analytical, verbal and written communication skills.
To apply
- All stated requirements must be 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
Claims (Review & Recovery) Supervisor
APWU Health Plan, a non-profit organization located in Elkridge, MD, is seeking a Claims Supervisor (Review & Recovery) to join our Claims Department.
The Review and Recovery Supervisor is responsible for managing the claims inventory and Review and Recovery staff through timely and accurate processing of higher level claims. Additionally, managing the processing of claims adjustments through the correction of errors and handling of overpayments and underpayments. Managing reporting and working of reports pertinent to this unit in a timely and accurate manner.
RESPONSIBILITIES
- Meet given objectives pertaining to cycle time, QA and productivity.
- Operate within the unit administrative budget.
- Manage unit workflow and inventory.
- Respond to staff questions quickly and accurately.
- Maintain reporting of daily/monthly activities and goals of the unit.
- Update standards and write/update unit procedures on a timely basis and as needed.
- Administer Plan personnel policies/CBA accurately and equitably.
- Complete assignments in a timely manner.
- Initiate IT tickets for system issues.
- Respond to other departments’ inquiries timely.
- Manage all of the R&R reports in a timely manner and accurately report those results as needed on a given timeline.
- Ensure cross-training of staff on all ‘specialty’ claim types.
- Provide supplemental training to staff as needed.
- Participate and/or collaborate on assigned Health Plan projects, committees and meetings.
- Other duties as assigned.
REQUIREMENTS
- AA degree (or commensurate experience) preferred.
- Must have QNXT processing experience.
- Must have subrogation, Medicare, Medicaid and OIC/COB experience.
- Decision making/problem-solving skills.
- Motivational/leadership skills.
- Good verbal and written communication skills.
- 4+ years’ experience in a supervisory/work leader capacity.
- Extensive claims and claims adjustment knowledge.
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.
To apply
- All stated requirements must be 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.