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Provider services representative vs enrollment representative

The differences between provider services representatives and enrollment representatives can be seen in a few details. Each job has different responsibilities and duties. It typically takes 6-12 months to become both a provider services representative and an enrollment representative. Additionally, a provider services representative has an average salary of $33,858, which is higher than the $31,463 average annual salary of an enrollment representative.

The top three skills for a provider services representative include customer service, data entry and patients. The most important skills for an enrollment representative are home health, customer service, and data entry.

Provider services representative vs enrollment representative overview

Provider Services RepresentativeEnrollment Representative
Yearly salary$33,858$31,463
Hourly rate$16.28$15.13
Growth rate-4%-4%
Number of jobs252,118185,567
Job satisfaction--
Most common degreeBachelor's Degree, 41%Bachelor's Degree, 52%
Average age4040
Years of experience1212

What does a provider services representative do?

A provider services representative is responsible for supporting, developing, and maintaining service relationships with involved participants, including providers, physicians, and administrators. Your duties typically include responding to direct and electronic questions from clients about rates, policies, referrals, and eligibility, handling telephone calls for the provider and member inquiries, and resolving complaints by the member and member representative. In addition, you will be assisting in collecting supporting data and documentation about the member's care. You are also expected to conduct research to be able to provide a well-informed answer to members' inquiries.

What does an enrollment representative do?

An enrollment representative directly communicates with clients when it comes to enrollment programs. Although their duties vary on their place or industry of employment, it typically includes helping enrollees understand the program requirements and rules, reaching out to enrollees to provide updates, gathering and processing applications, answering inquiries, and collecting payments when necessary. They also perform clerical tasks such as preparing and processing documents, updating databases, and maintaining records. Moreover, an enrollment representative must maintain an active communication line with staff for a smooth and efficient workflow.

Provider services representative vs enrollment representative salary

Provider services representatives and enrollment representatives have different pay scales, as shown below.

Provider Services RepresentativeEnrollment Representative
Average salary$33,858$31,463
Salary rangeBetween $24,000 And $46,000Between $25,000 And $38,000
Highest paying CityNew York, NYTemecula, CA
Highest paying stateNew YorkCalifornia
Best paying companyOracleCurry College
Best paying industryHealth CareNon Profits

Differences between provider services representative and enrollment representative education

There are a few differences between a provider services representative and an enrollment representative in terms of educational background:

Provider Services RepresentativeEnrollment Representative
Most common degreeBachelor's Degree, 41%Bachelor's Degree, 52%
Most common majorBusinessBusiness
Most common college--

Provider services representative vs enrollment representative demographics

Here are the differences between provider services representatives' and enrollment representatives' demographics:

Provider Services RepresentativeEnrollment Representative
Average age4040
Gender ratioMale, 22.2% Female, 77.8%Male, 29.1% Female, 70.9%
Race ratioBlack or African American, 11.5% Unknown, 5.1% Hispanic or Latino, 20.4% Asian, 6.4% White, 55.9% American Indian and Alaska Native, 0.7%Black or African American, 9.6% Unknown, 5.4% Hispanic or Latino, 21.8% Asian, 6.6% White, 55.9% American Indian and Alaska Native, 0.7%
LGBT Percentage7%7%

Differences between provider services representative and enrollment representative duties and responsibilities

Provider services representative example responsibilities.

  • Coach, evaluate and performance manage MSRs to ensure timely and accurate service to clients.
  • Achieve excellent customer satisfaction ratings as documented by CIGNA surveys.
  • Proof reading contracts in order to adjust claims according to proper DRG, ICD-9, and CPT codes.
  • Complete the surgery schedule and ensure all patients are aware of their financial responsibility prior to the surgery date.
  • Help providers with all information about CPT codes such as authorizations, restrictions, fee schedules, and correct diagnosis codes.
  • Register patients for surgery in computer system.
  • Show more

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.
  • Show more

Provider services representative vs enrollment representative skills

Common provider services representative skills
  • Customer Service, 24%
  • Data Entry, 6%
  • Patients, 5%
  • Medicaid, 5%
  • Health Insurance, 4%
  • Appeals, 3%
Common enrollment representative skills
  • Home Health, 22%
  • Customer Service, 18%
  • Data Entry, 10%
  • Patients, 6%
  • CMS, 4%
  • Enrollment Process, 4%

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