Benefits advisor vs provider enrollment specialist

Differences between benefits advisor and provider enrollment specialist duties and responsibilities

Benefits advisor example responsibilities.

• Manage broker and group accounts throughout the year administering qualify changes, terminations, and ACA compliance.
• Create reports using SQL database and manage reports, perform from internet-base tools for research projects need for client insight.
• Function as a liaison between the patient, hospital and governmental agencies to obtain documentation require for Medicaid eligibility determination.
• Maintain employee benefit records in HRIS system, including qualifying event records, personal information updates, and employment status changes.
• Evaluate patients for existing insurance coverage, federal and state assistance programs, or hospital charity application.
• Use tactful and effective interview techniques to obtain pertinent information to assure accurate eligibility determination for Medicaid.
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Provider enrollment specialist example responsibilities.

• Manage federal and state-mandate physician credentialing activities; act as NCQA committee liaison.
• Provide enrollment counseling to eligible recipients about Medicaid manage care and promote their voluntary enrollment into an HMO.
• Review provider enrollment applications to ensure the credentials and licenses meet all requirements for participation in the Medicare program.
• Verify provider is eligible to participate in Medicare according to CMS guidelines.
• Verify claim information using ICD-9 and medical terminology and CHAMPUS/ TRICARE guidelines .!
• Complete require forms and application for changes or updates in billing systems including EFT and or notification of Athena.
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