Provider enrollment specialist vs senior benefits specialist

Differences between provider enrollment specialist and senior benefits 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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Senior benefits specialist example responsibilities.

• Develop and manage leave of absence program in accordance with company policy, FMLA and applicable state laws.
• Create reports using SQL database and manage reports, perform from internet-base tools for research projects need for client insight.
• Coordinate with STD/FMLA carrier and payroll to process disability and FMLA claims.
• Set up new hires in Kronos time & labor system as well as work schedules.
• Act as liaison with vendors to insure accurate and timely claims processing according to HCFA, HIPAA and Medicare guidelines.
• Prepare weekly payroll utilizing Kronos software.
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