Provider relations specialist vs credentialing specialist

Differences between provider relations specialist and credentialing specialist duties and responsibilities

Provider relations specialist example responsibilities.

• Design short and long term plans for PCPs to accomplish suggest benchmarks and growth of its membership.
• Provide keen oversight in developing and maintaining quality improvement programs while managing payroll.
• Organize and analyze CMS changes for distribution to the team.
• Meet or exceed productivity and quality goals base on CMS guidelines/directives.
• Establish and maintain positive and productive relations with network providers for Medicaid and Medicare.
• Assist in IPA profitability through the recruitment and contracting of key physicians, hospitals and ancillary organizations with target membership panels.
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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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