Credentialing specialist vs medication coordinator

Differences between credentialing specialist and medication 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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Medication coordinator example responsibilities.

• Manage patient's accounts collecting and billing financial statements, budgets and expertise with CPT and ICD-9 coding.
• Manage inpatient transfers to rehabilitation and medical facilities, along with preparing and monitoring outpatient billings insurance verification and referrals.
• Complete records after patients complete all medical appointments, typing intake forms and additional entries/forms, and obtain physician signatures.
• Navigate effectively through an electronic medical records (EMR) system.
• Develop plan for confidentiality of client and agency information through HIPAA guidelines.
• Perform Medicare and Medicaid audits on members using company medical policy and establish criteria for H.C.F.A.
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