Transcend Health Solutions, LLC VA (Veterans Affairs) Claims Analyst Remote · Full time Company website

Apply for VA (Veterans Affairs) Claims Analyst

Our mission is to identify and consistently meet and exceed our customer’s needs and financial goals by maximizing their claims revenue. We achieve this by providing industry-leading complex claims management and certified medical coding services. Our team combines extensive industry experience with innovative technology to drive revenue cycle efficiency and maximize financial performance.

Key Responsibilities

• 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.

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Required 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.

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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.