Credentialing specialist vs scheduling coordinator

Differences between credentialing specialist and scheduling 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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Scheduling coordinator example responsibilities.

• Manage medical records entering data with CPT and ICD-9 codes preserving an environment of thoroughness and accuracy.
• Manage payment postings, verify insurance coverage prior to patient appointments and advise patients of insurance referrals or authorizations require.
• Manage inpatient transfers to rehabilitation and medical facilities, along with preparing and monitoring outpatient billings insurance verification and referrals.
• Perform patient registration, insurance verification, and assist patients with scheduling radiology and chemotherapy appointments in a demanding environment.
• Enter all patient information in EMR system, scan all of patients medical record into EMR system and classify by sections.
• Check patient insurance coverage, determines if referral or authorization for surgery is needed.
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