VA Claims Specialist (U.S. Only)

Overview

We are seeking a detail-oriented and experienced VA Community Care Network (CCN) Claims Specialist to support high-volume claims processing and follow-up within the U.S. market. This role focuses exclusively on tasks performed within the VA CCN portal, including claims submission, status checks, payment resolution, and accounts-receivable follow-up.

Key Responsibilities

Claims Processing & Management

• Submit, track, and manage VA CCN medical claims through the VA portal.
• Review claims for completeness, accuracy, and compliance with VA regulations.
• Correct and resubmit denied or rejected claims.
• Maintain detailed claim records, documentation, and follow-up actions.

Accounts Receivable (A/R) & Follow-Up

• Conduct timely A/R follow-up on outstanding VA CCN claims.
• Investigate delayed payments, claim discrepancies, and processing issues.
• Communicate with VA representatives to resolve pending items professionally and efficiently.
• Maintain A/R aging categories and ensure consistent progress on high-volume workloads.

Compliance & Documentation

• Ensure all work aligns with VA CCN rules, federal guidelines, and internal policies.
• Protect sensitive data according to HIPAA and VA security requirements.
• Generate reports on claim status, aging, and resolution timelines.

Cross-Functional Collaboration

• Coordinate with billing, credentialing, patient services, and clinical teams to gather required claim details.
• Escalate systemic claim issues or trends to leadership with clear documentation.

Required Qualifications

• U.S.-based candidate with valid Social Security Number (mandatory for VA portal access).
• 2+ years of experience in VA CCN billing, medical claims processing, or healthcare RCM.
• Strong understanding of medical terminology, CPT/HCPCS/ICD-10 coding, and claims workflows.
• Experience working with high-volume claims environments.
• Excellent organizational skills and attention to detail.
• Strong written and verbal communication skills.
• Ability to work independently, manage deadlines, and prioritize effectively.

Preferred Qualifications

• Prior experience managing large VA claims A/R volumes.
• Familiarity with EMR, Clearing Houses, TriWest, OptumServe, or other payer-specific Community Care processes.
• Familiarity with eCW, Meditech, Medent, and Rycan (TruBridge)
• Experience generating operational or A/R reporting.

Work Environment

• Remote U.S.-based position.
• Requires secure workspace and adherence to privacy standards.
• Tools, training, and portal credentials provided.

Compensation

• Competitive and based on experience.
• Full benefits available depending on employment classification.