Benefits representative vs provider enrollment specialist

Differences between benefits representative and provider enrollment specialist duties and responsibilities

Benefits representative example responsibilities.

• Determine eligibility and process FMLA initial notification letters for employees which lead to immediate use of benefits.
• Service consumers inbound inquires via phone and live chat regarding HRA, FSA and HSA accounts.
• Work with clients to ensure ACA compliance.
• Train in and apply HIPAA privacy and security regulations and maintain strict confidentiality of claims.
• Contact any FSA or HRA groups concerning any outstanding payments for claims and/or admin fee invoices.
• Produce benefit-related reports from HRIS.
Show more

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.
Show more