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
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Claim Monitoring & Status Updates
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Track VA hospital claims through systems like HSRM (HealthShare Referral Manager) and eCAMS Provider Portal.
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Verify receipt of claims and follow up with VA representatives and Third-Party Administrators (TPAs) such as Optum or TriWest
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Authorization & Documentation
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Confirm VA authorizations for inpatient and outpatient services.
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Ensure the hospital requested an emergency care within 72 hours when applicable.
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Denial Management
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Investigate and resolve denials related to eligibility, missing authorizations, or medical necessity.
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Prepare appeals and submit supporting documentation as required.
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Communication
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Provide timely updates to internal teams and escalate issues when needed.
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Reporting
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Generate reports on claim aging, payment variances, and resolution timelines.
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Use Epic or similar systems for real-time account updates.
- Strong knowledge of VA billing processes, Community Care Network (CCN), and Veterans Care Agreements (VCA).
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Familiarity with UB-04 and CMS-1500 claim forms.
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Experience with electronic billing systems and portals (e.g., eCAMS, Epic).
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Excellent communication and problem-solving skills.
