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LISTING: Medical Claims Auditing Professionals for long-term VA Project (Remote)

Medical Claims Auditing Professionals for long-term VA Project (Remote)


Our client is looking for Five Medical Claims Auditing Specialists to abstract data from commercial payers that insure Veterans.  Ideal candidates may be either experienced health claims adjudicators or coding professionals with experience paying or auditing VA health care claims.  The extensive project is anticipated to be full time for 12 months with a start by July 1, 2020.


Job Function

To abstract data from Commercial Payers and essentially perform QC on pricing.  (determining what was charged vs. paid/ vs. what was negotiated for services in established contracts.  The auditors will be reviewing claims from seven VA billing centers.


Job Details and Requirements

  • Experience with Insurance/Claims Processing for the Veterans Administration VA)
  • Knowledgeable of how TPP claim paying interacts with VA Health Benefits
  • Experience reviewing collected/closed claims for the purpose of identifying those subjected to potential underpayment.
  • Interpret E-Remittance advice information or scanned paper EOB’s.
  • Tableau software proficiency is preferred
  • Experience working w/ Commercial (Governmental) Payers: Tricare, Medicare, etc.
  • Knowledge of the Title 38 USC Section 1729 & T38 CFR (Part 17.101 & part 17.106) – VA Payment Systems (Collection or recovery by VA for medical care for services furnished for a nonservice related disability)
  • VA Financial Policy Vol. XII, Chp. 5 (related to collecting from TPP for treatment of a non-service connected (NSC) disability or condition.) 
  • Experience with information security per the FISMA Act & HIPPA proficiency
  • Needs virtual A/V access (i.e. Skype, Zoom, Google Hangouts, etc.)


If you or anyone you know of is interested in this position, please email all resumes to us for immediate consideration.

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