Provider enrollment specialist vs benefits assistant

Differences between provider enrollment specialist and benefits assistant duties and responsibilities

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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Benefits assistant example responsibilities.

• Create reports using SQL database and manage reports, perform from internet-base tools for research projects need for client insight.
• Audit HIPAA and outgoing correspondence.
• Maintain strict confidentiality, observing HIPAA and other policies and guidelines.
• Post patient payments, verify insurance coverage for new and Medicaid patients.
• Provide information, education and assistance to clients regarding Medicare and Medicaid by phone and in person.
• Audit, correct and record all attendance records, vacation records, vacation carryover and vacation/sick accruals.
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