Credentialing specialist vs medical staff coordinator

Differences between credentialing specialist and medical staff coordinator 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 staff coordinator example responsibilities.

• Manage process and documentation of re-accreditation in accordance with NCQA standards.
• Ensure enrollment and participation with all organization contract managed care plans and perform Medicaid/Medicare provider enrollment.
• Maintain current knowledge of accreditation guidelines (TJC) and compliance with regulatory agencies (CMS).
• Maintain standards and processes for re-credentialing data ensuring database integrity, compliance with CMS and JCAHO regulatory bodies.
• Attend all meetings (weekly) and am responsible for keeping the meeting in compliance with ACCME standards for CME credit.
• Correspond with licensing boards, NPDB, hospitals, certification agencies, training programs and medical groups to resolve any issues.
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