Medical staff coordinator vs referral specialist

Differences between medical staff coordinator and referral specialist duties and responsibilities

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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Referral specialist example responsibilities.

• Manage assignments of paying medical bills limit in depth that include organizing and researching regulations as pertain to veterans eligibility.
• Interview patients, evaluate eligibility, collect co-pays, deductibles, including, but not limit to insurance verification.
• Input HIPAA information, call physician offices to verify testing, collect copay's and deductibles.
• Arrange for debt repayments or establish repayment schedules and send out insurance claims with the correct ICD-9 and CPT codes.
• Research referrals and either deny or approve based on information obtain and appropriately identify diagnosis (CPT and ICD-9 coding).
• Maintain confidentiality by following all applicable HIPAA regulations.
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