Provider enrollment specialist vs retirement specialist

Differences between provider enrollment specialist and retirement specialist 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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Retirement specialist example responsibilities.

• Manage and resolve participant escalations and requests from DOL.
• Lead major initiatives in 3concurrent roles successfully manage affluent personal and business portfolio to proactively cross-sell additional products and services.
• Review social security, Medicare, annuities and tax relate questions.
• Process recalculations and payroll for retirees resuming their retirement benefits.
• Utilize ASC and SRT recordkeeping systems.
• Educate participants, clients and third party facilitators on various ERISA regulations and procedures.
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