Credentialing specialist vs appointment scheduler

Differences between credentialing specialist and appointment scheduler duties and responsibilities

Credentialing specialist example responsibilities.

• Establish rapport with all PCP offices, hospital personnel, and manage care representatives.
• Manage and administer the programs CME accredit education programs/Conferences.
• Ensure enrollment and participation with all organization contract managed care plans and perform Medicaid/Medicare provider enrollment.
• Process and manage all requests and applications for CME certification and supervise activities relate to credentialing process.
• Perform spot claims audits to ensure CMS compliance with ICD-9, HCPCS, CPT, and other requirements.
• Maintain and track data for OPPE and FPPE according to hospital policy and regulatory requirements.
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Appointment scheduler example responsibilities.

• Manage patient pre-op responsibilities, and generate all necessary paperwork.
• Utilize the appropriate screening tools to accurately schedule internally refer patients for MRI appointments.
• Obtain and enter complete registration demographic and insurance verification information (primary and secondary) into EMR system.
• Implement a new TCMS and EHR database for the doctor's internal use.
• Organize & archive electronic documents; scan and link charts and documents into the EHR
• Used knowledge of key medical terms to determine patient's symptoms and refer to triage nurse when applicable.
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