[Hiring] VA Claims Analyst @Transcend Health Solutions

Role Description

• Review, submit, and monitor medical claims to Veterans Affairs, including VA Community Care, Emergent Care, CHAMPVA, and TRICARE.
• Verify patient eligibility and payer responsibility under VA guidelines and third-party insurance rules.
• Research VA regulations and authorization criteria to ensure compliant and accurate claim submission.
• Analyze denials and underpayments; draft and submit formal appeals to VA and affiliated programs.
• Read and interpret EOBs and remittance advices to determine claim status and appropriate follow-up actions.
• Work closely with hospitals, VA representatives, patients and third-party administrators (e.g., TriWest, Optum) to resolve outstanding claims.
• Ensure all submissions follow proper documentation and are compliant with HIPAA and VA requirements.
• Maintain detailed records of billing, appeals, correspondence, and claim outcomes for audit purposes.
• Escalate complex cases to leadership with a proposed resolution path.
• Meet productivity goals while maintaining excellent attendance, attention to detail, and accuracy.

Qualifications

• Expert knowledge of VA claims processes, including Community Care, Emergent Care, CHAMPVA, and TRICARE billing.
• Proven experience reading EOBs and writing effective appeals.
• Familiarity with VA portals such as HMS, TriWest, or Optum VA CCN platforms.
• Strong knowledge of medical terminology, coding (ICD-10, CPT, HCPCS), and healthcare billing principles.
• Excellent communication and problem-solving skills.
• Detail-oriented with the ability to manage multiple priorities and deadlines.
• Proven track record of excellent attendance and reliability.
• High School Diploma required; Bachelor’s degree preferred, or equivalent combination of education and experience.
• Minimum of 2 years’ experience in VA claims, medical billing, or claims resolution.

Preferred Skills

• Experience submitting claims to VA CCN administrators (TriWest or Optum).
• Understanding of VA authorization and referral processes.
• Familiarity with hospital lien regulations and coordination of benefits.
• EHR experience.