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.
Minimum Qualifications
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
Desired Qualifications
Strong oral and written communication skills.
Excellent interpersonal skills.
Critical thinking skills.
Cultural competency.
Integrity and honesty.
Strong attention to detail.
Physical Requirements
Physical Requirements: While performing the duties of this job, the employee is regularly required to sit for extended periods, use a computer keyboard and mouse, and communicate verbally and in writing. The employee may occasionally need to stand, walk, bend, or lift up to 15 pounds. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.
About Aptive
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: 2012Employees: 300+ nationwide
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.
