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.
