Provider Relations Liaison (Claims Specialist)

Job Summary

Aptive is seeking a Provider Relations Liaison to support ICE Health Services Corps (IHSC) . IHSC's mission is to provide medical care to maintain the health of individuals in the custody of ICE . IHSC is committed to ensuring a system of care that is ethical, responsible, and accountable through rigorous surveillance and monitoring activities . The Provider Relations Liaison at Aptive will play a key role in providing this support to IHSC and achieving their mission.

The Provider Relations Liaison (PRL) is the incumbent responsible for being a liaison between IHSC, offsite providers and the Veterans Affairs Financial Services Center (VAFSC). Liaison with community-based providers that provide or are interested in providing medical and mental health services for ICE detainees regarding Medicare reimbursement rates, Letters of Understanding, credentialing requirements, medical claims processing, payment and denials.

This position requires on-site hybrid support at our client location.

Primary Responsibilities

• Serve as one of the primary points of contact and liaison for Veterans Administration (VA) Financial Services Center (FSC) issues relating to medical claims processing, resolution, and provider reimbursement.
• Evaluate, assess, and recommend reimbursement methodologies and procedures to community providers.
• Responsible to identify potential fraud, waste and abuse when working with community providers.
• Reconcile and resolve denied community provider claims and/or appeals .
• Contacts community providers for recruitment and enrollment into the IHSC provider network by executing a Letter of Understanding.
• Liaises with IHSC stakeholders (Field Medical Coordinators and Referral Coordinators) when necessary to explain IHSC and VA FSC policy regarding claims processing.
• Assist VA FSC when necessary, in coordinating and obtaining information pertaining to Medical Provider Authorization Requests ( MedPARs ) or information pertaining to eligibility in the alien tracking system.
• Coordinate the purchase or rental of durable medical equipment (DME) for detainees in ICE custody.
• Performs record keeping functions in accordance with program policies and position.
• Maintains functional proficiency and ease of use utilizing electronic health records as required by, and appropriate to , position.
• Completes all initial , annual and ad hoc training as required/assigned.
• Serves as a team member for analyzing established protocol practices and identifying areas for improvement.
• Maintains patient confidentiality, and confidentiality of all records, in compliance with the Privacy Act and HIPAA regulations in all work activities.
• Adheres to, and maintains awareness of, IHSC Policies, Procedures, Directives, Operational Memoranda and accreditation standards as prescribed by ICE/IHSC.
• Attends and participates in general/medical staff meetings.
• Other duties as assigned.

Minimum Qualifications

• Bachelor's degree in healthcare ad m i nistration, business, or financial m anage m ent .
• A m i n i m u m three years of experience in clai m s m anage m ent, benefit, or third-party ad m i nistration.
• Knowledge of the basic principles and standards of eHR procedures and methods.
• Knowledge of the documentation requirements, timeliness of referral management, and knowledge of eHR workflow to process electronic medical referrals and records, to review referrals and records for accuracy and completeness.
• Bas ic fluency of medical terminology.
• Recognize documentation inconsistencies in referrals within the eHR ensuring compliance and resolution.
• Should possess some knowledge of International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), current procedural terminology (CPT), diagnosis-related group (DRG), and other Centers for Medicare and Medicaid Services (CMS) coding/billing requirements.
• Ability to work approximately 90% of time using a computer, telephone, scanner, and printers.
• Ability to work in a multi-cultural and multi-lingual environment.
• Ability to adapt to sudden changes in schedules and flexibility in work requirements.
• Ability to communicate proficiently in English (verbal and written) in order to develop positive rapport with co-workers and other stakeholders.
• Ability to establish and maintain positive working relationships in a multidisciplinary environment.
• Ability to navigate in an electronic work environment including electronic health records, web-based training and communications.
• Knowledge of, and moderate proficiency in, common Microsoft Office programs, specifically Microsoft Word, Excel, Outlook and SharePoint.
• Knowledge of regulations (HIPAA/Privacy Act) regarding the confidentiality of patient medical records and information as well as Personally Identifiable Information (PII).
• Ability to obtain and maintain a government security clearance as required for the position

Desired Qualifications

• Previous experience supporting a federal program, experience with IHSC highly desired
• P roject management experience
• M ilitary veterans are encouraged to apply

Client Information

IHSC's mission is to provide medical care to maintain the health of individuals in the custody of ICE through an integrated health care delivery system, based on nationally recognized correctional, detention and residential health care standards . The Agency is committed to providing healthcare services to protect the nation's health, reduce global disease and provide medical support for the law enforcement mission of the safe apprehension, enforcement and removal of detained individuals involved in immigration proceedings. IHSC is committed to ensuring a system of care that is ethical, responsible, and accountable through rigorous surveillance and monitoring activities.

About Aptive

Aptive is a modern federal consulting firm focused on human experience, digital services, and business transformation. We harness creativity, technology, and culture to connect people and systems to impact the world. We're advisors, strategists, and engineers focused on people, above all else.

We believe in generating success collaboratively, leaving client organizations stronger after every engagement and building trust for the next big challenge. Our work inspires people, fuels change and makes an impact. Join our team to be part of positive change in your community and our nation.

EEO Statement

Aptive is an equal opportunity employer. We consider all qualified applicants for employment without regard to race, color, national origin, religion, creed, sex, sexual orientation, gender identity, marital status, parental status, veteran status, age, disability, or any other protected class.

Veterans, members of the Reserve and National Guard, and transitioning active-duty service members are highly encouraged to apply.