Enrollment specialist vs verification specialist

Differences between enrollment specialist and verification 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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Verification specialist example responsibilities.

• Manage the TRICARE information program by presenting information utilizing available media, group presentations, or mailings.
• Maintain confidentiality of all patient medical information adhering to HIPPA regulations and Medicare / Medicaid policies.
• Verify primary insurance eligibility by phone with agents or online regarding Medicaid recipients and to determine payment responsibilities to providers.
• Verify medical coverage and benefits to providers and members, review certain ICD9 and CPT codes.
• Verify patient effective date of insurance, including CPT and diagnosis codes and general policy information.
• Receive extensive training on insurance plans and types, HIPAA compliance, PatientPlus programming and other workplace relate topics.
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