Physician specialist vs credentialing specialist

Differences between physician specialist and credentialing specialist duties and responsibilities

Physician specialist example responsibilities.

• Manage providers' office and call schedules, outlook calendars and assist with surgery scheduling.
• Generate referral letters for physicians, manage and sort medical documents within the EHR system, and assist with e-prescribing.
• Review complete ultrasound and non-stress testing reports and assign appropriate ICD-10 and CPT codes.
• Train in AllScripts EMR system.
• Retrieve medical records from EMR and save to flash drive.
• File written letters of appeal on claims deny by the Medicaid.
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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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