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.