VA Claims Follow-Up Specialist

SYNTRIQ HEALTH SOLUTIONS LLC • Corinth, MS

2d

About The Position

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.

Requirements

• 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.

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.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed
• Number of Employees: 1-10 employees