Enrollment specialist vs provider enrollment specialist

Differences between enrollment specialist and provider enrollment specialist duties and responsibilities

Enrollment specialist example responsibilities.

• Manage the TRICARE information program by presenting information utilizing available media, group presentations, or mailings.
• Manage customer relations with internal personnel, group administrators, brokers and members as related to HMO commercial insurance.
• Maintain records pertaining to eligibility and enrollment by managing CMS reports.
• Provide enrollment counseling to eligible recipients about Medicaid manage care and promote their voluntary enrollment into an HMO.
• Analyze, process and manage FMLA claims to determine eligibility and certification in compliance with state and federal regulations.
• Assist medical assistance consumers with choosing HMO's and PCP as well as with HMO and PCP transfers.
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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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