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
HIPAA Compliance Specialist
The APWU Health Plan, a non-profit organization located in Elkridge, MD, is seeking a HIPAA Compliance Specialist to join our Compliance Department.
The HIPAA Compliance Specialist is responsible supporting the efforts of the APWU Health Plan to comply with applicable laws, regulations and accreditation standards.
PRIMARY ACCOUNTABILITIES:
- Notify the Senior Program Manager Accreditation and HIPAA Privacy Compliance management whenever policies and procedures relating to security, confidentiality, and privacy are not being followed.
- Assist in developing training modules with staff in Compliance, Human Resources and Operations for handling confidential data and privacy of individually identifiable health information.
- Collect data and records for reporting.
- Conduct annual Virtual Credentialing/Re-Credentialing of vendor provider file reviews.
- Perform other duties as assigned.
QUALIFICATIONS:
- Bachelor degree preferred with a minimum of 1-2 years of health plan experience.
- Knowledge of Health Equity preferred.
- Understanding of HIPAAs regulations, requirements, and guidelines.
- Ability to prioritize and manage multiple projects in accordance with the priorities set by the leadership.
- Proven track record of effectively and productively working with varied levels of personnel including with external personnel 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
Utilization Analyst
The APWU Health Plan is seeking a Utilization Analyst to join our Utilization Management Department. This position assures the Health Plan remains competitive by identifying, designing, recommending, implementing and evaluating health care programs that control utilization and benefit expense.
Primary Accountabilities:
- Identify and seek out potential programs and vendors that support utilization management and makes recommendations to senior staff on initiatives and strategies that support the corporate mission.
- Advise on industry trends and identifies the need for new or revised utilization management programs and practices.
- Direct quarterly trend reviews and forecasting analysis
- Other duties as assigned.
Qualifications:
- Identify and seek out potential programs and vendors that support utilization management and makes recommendations to senior staff on initiatives and strategies that support the corporate mission.
- Advise on industry trends and identifies the need for new or revised utilization management programs and practices.
- Direct quarterly trend reviews and forecasting analysis
- Other duties as assigned.
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.