VA Insurance & Massage Therapy Billing Specialist

VA Insurance & Massage Therapy Billing Specialist.

• VA Insurance System Setup and Integration:

• Guide the clinic to complete registration and credentialing with SAM.gov, CCN (Community Care Network), and Tri West/Optum.
• Assist in establishing and managing Clearinghouse (Availity/Office Ally, etc.) accounts to ensure smooth claim submissions.
• Liaise with VA Case Managers to verify patient authorizations and ensure compliance.

• Billing and Compliance Management:

• Responsible for submitting, auditing, and tracking VA insurance claims to avoid denials or delays.
• Ensure proper use of CPT/ICD-10 coding in alignment with authorization letters.
• Establish claim tracking mechanisms; initiate follow-ups if payments are not received within 30 days.

• Clinical Service Compliance Support

• Provide guidance to massage therapists on SOAP note documentation to ensure HIPAA compliance.
• Review clinical documentation to ensure it meets VA audit and payment standards.

• Team Training and SOP Development:

• Train front desk and billing staff on VA insurance billing workflows and system operations.
• Develop and implement Billing SOPs (Standard Operating Procedures) to ensure independent execution.
• Create compliance checklists and perform periodic audits and updates.

• Optimization and Strategic Planning:

• Analyze claim denials or payment delays and propose improvement strategies.
• Provide long-term strategic planning for VA-related business to support revenue growth and clinic expansion.
• Monitor VA policy updates and CCN rule changes to ensure timely operational adjustments.

• Job Objectives:

• Ensure the clinic achieves a VA insurance claim compliance rate of over 95%.
• Reduce claim payment cycles to within 30–45 days.
• Build a replicable VA insurance billing system to support future multi-location expansion.