HMO Biller

Job Title Run the AR every 4 weeks. Make sure the claims were paid correctly. Denials must be checked, sent appeal, Check authorization and eligibility. Make phone calls if the denial is not clear, have the claims reprocess, etc. Timely Filing, make sure claims are out before it hit timely filing. Send corrected claims, if needed Sending out invoices to the patient for copay and deductible Write-off Posting payments Bill HMO Claims Must check and work on denied claims every week. Check on Waystar daily if any claims are rejected. The payments must be posted no later than 1 week after getting the remittance. Eligibility check 1st and 15th of the month. Claims submission once a week Billing straight Medicaid as secondary. Deductible and copay can be billed to Medicaid as secondary if patient has straight Medicaid. If you have Health First as your account, make sure to check HHAX portal for failed EVV.