Credentialing specialist vs medical receptionist

Differences between credentialing specialist and medical receptionist 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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Medical receptionist example responsibilities.

• Conduct analysis to address long wait times which lead to faster triage, shorter wait times.
• Evaluate all EOB's to insure accurate payment is received and when necessary will file appeals to achieve optimal payments.
• Greet and check-in patients, including obtaining accurate patient demographic information, patient registration, and checking insurance eligibility.
• Learned and operate chiropractic equipment (decompression; Leander) & x-rays; enabling Dr to have more time for patients.
• Resolve concerns of terminally ill patients with compassion and professionalism.
• Identify patients' specific scheduling requirements while demonstrating care and compassion via telephone.
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