VA Claims Specialist

4 days ago

Oak Brook, Illinois, United States Jorie AI Full time $110,400 - $129,600 per year

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.

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