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. 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.