Medical Claims Manager Jobs in Reston, VA (NOW HIRING)

The ICE Health Services Corps (IHSC) exists within the organizational structure of the United States Immigration and Customs Enforcement (ICE), Enforcement and Removal Operations (ERO) under the supervision of the Department of Homeland Security (DHS). The United States Public Health Service (USPHS) Commissioned Corps Officers, civil service staff and contractors comprise the healthcare professionals working together to provide quality healthcare services. IHSC serves as the medical experts for ICE for detainee health care.

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.

• 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.

• Bachelor's degree in healthcare administration, business, or financial management.
• A minimum three years of experience in claims management, benefit, or third-party administration.
• 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
• Recognize documentation inconsistencies in referrals within the eHR ensuring compliance and resolution.
• Should possess some knowledge of lnternational 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).
• Onsite requirement is 2 days a month

• Strong oral and written communication skills.
• Excellent interpersonal skills.
• Critical thinking skills.
• Cultural competency.
• Integrity and honesty.
• Strong attention to detail.

Aptive partners with federal agencies to achieve their missions through improved performance, streamlined operations and enhanced service delivery. Based in Alexandria, Virginia, we support more than a dozen agencies including Veterans Affairs, Transportation, Defense, Homeland Security and the National Science Foundation.

We specialize in applying technology, creativity and human-centered services to optimize mission delivery and improve experiences for millions of people who count on government services every day.

Founded: 2012
Employees: 300+ nationwide

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.