Grow your career at APWU Health Plan
Trainer/Work Measurement/Procedure Analyst
APWU Health Plan is seeking a Trainer/Work Measurement/Procedure Analyst to join our Training and Productivity Department. This position develops, updates, maintains and facilitates training programs and work measurement standards for all business departments. Additionally, supports business areas by driving process improvement and accurate procedures.
RESPONSIBILITIES
- Develop and facilitate in-house or hybrid training.
- Develop and disseminate work measurement standards.
- Evaluate the effectiveness of training and development.
- Evaluate the integrity of standards on an ongoing basis.
- Perform workflow analysis and make recommendations for improved efficiency.
- Gain proficiency and fluency in all business unit work types.
- Address procedure requests and coordinate tasks to ensure our online procedure manual is current.
- Support Health Plan projects as assigned.
- Perform other duties as assigned.
REQUIREMENTS
- BA degree (or commensurate experience) preferred.
- Excellent public speaking proficiency.
- Full understanding of healthcare processing systems (i.e., claims adjudication, data entry, imaging, workflow, etc.).
- Experienced in techniques associated with development, implementation and presentation of training and standards programs.
- Excellent oral, writing, and editing skills.
- Exceptional organizational and time management skills.
- Proven ability to positively influence and collaborate with business users and stakeholders.
- Strong critical thinking and problem-solving expertise.
- Ability to thrive in working independently and collaboratively.
- Proven capacity for developing workshops and seminar materials.
- Experience in processing claims, handling member and provider calls, familiarity with Health Plan enrollment, provider file, data entry and mail sort areas 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
Applications Programmer I
APWU Health Plan is seeking an Applications Programmer I to join our Applications Development Department.
NATURE AND SCOPE
- This position reports to the Team Lead, Applications Development.
- This position is responsible for developing accurate and efficient computer programs adhering to established standards. The incumbent is responsible for changes/enhancements to existing systems.
- This position will interface with users and Business and System Analysts as well as vendors and subject matter experts in designing systems or enhancements or correcting defects found during uses.
- The incumbent will work with others as needed to obtain or create test data as required to validate system changes/enhancements.
RESPONSIBILITIES
- Assist in the development of computer programs including the testing of the finished program before formal testing and production turnover.
- Responsible for daily EDI review and correction for inbound transactions including but not limited to 834, 837, 277, proprietary and flat files.
- Work according to the direction of or project plans laid out by the Team Lead, Applications Development, Manager Application Development or their designee.
- Perform other duties as requested.
REQUIREMENTS
- Associates degree in related field preferred but 2 years of direct experience may be substituted.
- Familiarity and understanding of HTTP/FTP/SFTP concepts.
- Knowledge of CAQH CORE requirements, HITECH, ACA and other government mandates.
- Experience in SQL Server, Visual Studio, ASP.NET, C# and development tools for ETL a plus.
- Experience with health insurance systems, claims processing systems, financial systems, budget and expense systems and utilization systems a plus.
This is a union position.
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
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
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.