Provider relations representative vs enrollment representative

Differences between provider relations representative and enrollment representative duties and responsibilities

Provider relations representative example responsibilities.

• Help manage ACO program and review measures with provider offices.
• Advise clients on health care and manage care products including POS, PPO and medical management programs.
• Provide keen oversight in developing and maintaining quality improvement programs while managing payroll.
• Manage software maintenance renewal partner and assist with upselling additional and higher functionality licenses to increase revenue.
• Review the provider contracts, paid members claims, base on the CPT code & ICD-9 that are submitted.
• Review provider claims for CPT and ICD-9 coding accuracy and generate payment of claims base upon current fee schedule.
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Enrollment representative example responsibilities.

• Achieve excellent customer satisfaction ratings as documented by CIGNA surveys.
• Audit all tickets for proper labs, correct ICD-9 coding and CPT coding.
• Learned ICD-9 codes and medical billing to insure prompt and accurate processing of claims.
• Resolve claims by verifying CPT and ICD-9 coding and the expected reimbursement per contractual agreements with varying insurance providers.
• Proofread any errors than may occur, fax, file, track all PCP forms
• Adhere to all key audit controls and comply with all establish standards associate with HIPAA, SOX and SAS70.
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