Utilization coordinator vs medical staff coordinator

Differences between utilization coordinator and medical staff coordinator duties and responsibilities

Utilization coordinator example responsibilities.

• Manage and coordinate authorization of denial letters and request for appeals with all levels of services.
• Manage and coordinate the workload of the release team members and are responsible for organizing and hosting all production release windows.
• Perform accurate verification of eligibility and benefits as well as advanced application of CPT, ICD-9 and ICD-10 codes.
• Assign accurate ICD-9 and CPT codes to request services for referral and authorization processing.
• Claim adjudication for assign HMO members.
• Provide orientation to pre-certification process for HMO, PPO, and POS members.
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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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