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.