Benefits analyst vs provider enrollment specialist

Differences between benefits analyst and provider enrollment specialist duties and responsibilities

Benefits analyst example responsibilities.

• Manage relationships with all FSA clients including supporting their employee inquiries, reporting, and explain policy and procedure.
• Manage regulatory compliance with federal and state leave laws such as FMLA, ADA, CFRA, PDL and FEHA.
• Create reports using SQL database and manage reports, perform from internet-base tools for research projects need for client insight.
• Develop data analysis procedures to comply with ACA regulations.
• Screen clients for Medicaid and other health insurance eligibility.
• Provide functional expertise and leadership of retiree benefits administration during the RFP selection process for outsourcing retirement administration.
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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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