VA Claims Follow-Up Specialist

The VA Claims Follow-Up Specialist will ensure timely and accurate resolution of Veterans Administration hospital claims by proactively monitoring claim status, addressing denials, and maintaining compliance with VA policies and federal regulations.

Key Responsibilities

• Claim Monitoring & Status Updates
  • Track VA hospital claims through systems like HSRM (HealthShare Referral Manager) and eCAMS Provider Portal.
  • Verify receipt of claims and follow up with VA representatives and Third-Party Administrators (TPAs) such as Optum or TriWest
• Authorization & Documentation
  • Confirm VA authorizations for inpatient and outpatient services.
  • Ensure the hospital requested an emergency care within 72 hours when applicable.
• Denial Management
  • Investigate and resolve denials related to eligibility, missing authorizations, or medical necessity.
  • Prepare appeals and submit supporting documentation as required.
• Communication
  • Provide timely updates to internal teams and escalate issues when needed.
• Reporting
  • Generate reports on claim aging, payment variances, and resolution timelines.
  • Use Epic or similar systems for real-time account updates.

Qualifications

• Strong knowledge of VA billing processes, Community Care Network (CCN), and Veterans Care Agreements (VCA).
• Familiarity with UB-04 and CMS-1500 claim forms.
• Experience with electronic billing systems and portals (e.g., eCAMS, Epic).
• Excellent communication and problem-solving skills.