Provider Relations & Claims Liaison

Aptive; Washington (District of Columbia); Hybrid; USD 60,000 - 90,000; Full time

Job summary

Aptive seeks a Provider Relations Liaison to serve IHSC, coordinating with offsite providers and VA FSC on Medicare reimbursement and documentation. You will manage referrals, credentialing, and claims processing while ensuring HIPAA compliance and data integrity.

Based in the Washington, DC area, the role requires strong communication and multitasking in a multi-cultural environment; onsite presence is limited to two days monthly with flexible work arrangements.

Qualifications

• Bachelor's degree in healthcare administration, business, or financial management.
• At least three years of experience in claims management, benefit, or third-party administration.
• Familiarity with eHR procedures and referral management.
• Understanding of ICD-10, CPT, DRG, and CMS coding/billing basics.
• Strong computer usage skills and ability to work in multi-cultural settings.
• English communication skills (verbal and written) required.

Responsibilities

• Serve as liaison between IHSC, offsite providers and VA FSC for claims processing and reimbursement.
• Assess reimbursement methodologies and advise community providers.
• Identify potential fraud, waste, and abuse in provider interactions.
• Reconcile denied claims and appeals with providers.
• Recruit and enroll providers into the IHSC network via Letters of Understanding.
• Coordinate with IHSC stakeholders to explain policy on claims processing.
• Assist in obtaining Medical Provider Authorization Requests and alien-tracking eligibility data.
• Coordinate the purchase or rental of durable medical equipment for detainees.
• Maintain records per program policies and HIPAA requirements.
• Operate electronic health records and complete required trainings.

Skills

Claims management

eHR workflows

HIPAA compliance

Microsoft Office

English communication

Multi-cultural environment

Education

Bachelor's degree in healthcare administration

Tools

SharePoint

Excel

Outlook

Job description

Aptive seeks a Provider Relations Liaison to serve IHSC, coordinating with offsite providers and VA FSC on Medicare reimbursement and documentation. You will manage referrals, credentialing, and claims processing while ensuring HIPAA compliance and data integrity.

Based in the Washington, DC area, the role requires strong communication and multitasking in a multi-cultural environment; onsite presence is limited to two days monthly with flexible work arrangements.