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

Apply for VA (Veterans Affairs) Claims Analyst

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.