Job Description

VA/WC Claims & Authorization Specialist (Authorizations, Medical Billing, Compliance) Job Overview

This dual-function role manages authorizations, claims processing, and payer communications for Veterans Affairs (VA) and Workers' Compensation (WC) lines of business. The company provides essential medical equipment and services to Veterans and Workers' Compensation patients through efficient authorization and billing operations. This position is critical to the revenue cycle, requiring navigation of complex regulatory frameworks and compliance.

• Directly impact the company's revenue cycle by managing critical VA and Workers' Compensation authorizations and claims.
• Navigate and ensure compliance with complex regulatory frameworks including HIPAA, VA protocols, and WC laws.
• Build and maintain strong relationships with VA Purchasing Agents and Workers' Compensation adjusters.
• Achieve full operational autonomy within 90 days, with opportunities to contribute to process improvements.

• A detail-oriented professional capable of managing competing priorities in a highly regulated environment.
• Someone with a strong background in healthcare authorizations and medical billing.
• An individual adept at navigating complex regulatory frameworks, including HIPAA, VA protocols, and Workers' Compensation laws.
• A proactive communicator skilled in building relationships and negotiating with payers and agents.

• Manage VA Request for Service (RFS) status checks, resubmissions, and documentation accuracy.
• Respond promptly to VA Purchasing Agents' Requests for Quotes and verify Purchase Orders.
• Prepare and submit authorization requests to Workers' Compensation adjusters and TPAs.
• Proactively follow up with adjusters and TPAs to expedite authorization processes.
• Maintain accurate records of all authorization requests, communications, and outcomes.
• Generate reports on claim status and payment resolution.
• Ensure strict compliance with HIPAA, VA protocols, and Workers' Compensation laws.

• Proven experience in Healthcare Authorizations and Medical Billing.
• Strong understanding and adherence to HIPAA Compliance.
• Demonstrated negotiation skills for payer communications.
• Familiarity with Workers' Compensation Regulations (preferred).
• Ability to manage competing priorities in a regulatory-heavy environment.
• Exceptional attention to detail and accuracy in documentation.
• Experience with VA protocols and workflows is highly beneficial.

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