Credentialing specialist vs scheduler

Differences between credentialing specialist and 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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Scheduler example responsibilities.

• Manage clinic visit schedules, rehabilitation conferences, medical exams, trial appearances, depositions, etc.
• Utilize knowledge of medical insurance including manage care, Medicare, Medicaid, liability and workman's compensation.
• Manage patient pre-op responsibilities, and generate all necessary paperwork.
• Schedule procedure, surgery f/u, register new patients, referrals, insurance, send nurse messages.
• Schedule patients for test and surgery procedures with and without anesthesia using the Surgi-Server computerize scheduling system.
• Schedule patients for radiology and nuclear medicine procedures, verify insurance benefits, and obtain prior authorizations for patient procedures.
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