Credentialing specialist vs referral coordinator

Differences between credentialing specialist and referral 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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Referral coordinator example responsibilities.

• Establish rapport with all PCP offices, hospital personnel, and manage care representatives.
• Ensure CPT and ICD-9 coding are accurate and complete according to AMA's guidelines and for third party intermediaries.
• Contact medical insurance companies and provide ICD-9 diagnosis and CPT procedure codes for patient's illness, condition or injury.
• Apply ICD-9 and CPT-4 codes to complete referral requests online or via fax.
• Conduct the entire office's EHR process and create a system to track old and new patient's records.
• Incorporate core organizational values of quality, respect, integrity, partnership, and compassion in all activities and decisions.
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