Verification specialist vs benefits representative

Differences between verification specialist and benefits representative duties and responsibilities

Verification specialist example responsibilities.

• Manage the TRICARE information program by presenting information utilizing available media, group presentations, or mailings.
• Maintain confidentiality of all patient medical information adhering to HIPPA regulations and Medicare / Medicaid policies.
• Verify primary insurance eligibility by phone with agents or online regarding Medicaid recipients and to determine payment responsibilities to providers.
• Verify medical coverage and benefits to providers and members, review certain ICD9 and CPT codes.
• Verify patient effective date of insurance, including CPT and diagnosis codes and general policy information.
• Receive extensive training on insurance plans and types, HIPAA compliance, PatientPlus programming and other workplace relate topics.
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Benefits representative example responsibilities.

• Determine eligibility and process FMLA initial notification letters for employees which lead to immediate use of benefits.
• Service consumers inbound inquires via phone and live chat regarding HRA, FSA and HSA accounts.
• Work with clients to ensure ACA compliance.
• Train in and apply HIPAA privacy and security regulations and maintain strict confidentiality of claims.
• Contact any FSA or HRA groups concerning any outstanding payments for claims and/or admin fee invoices.
• Produce benefit-related reports from HRIS.
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