Blurred Lines: Mastering Payor Enrollment

The specialty lines within the Medical Staff Services industry are changing.  The boundaries of work functions primarily found in Medical Staff Services Departments (MSSD), Credentials Verification Organizations (CVO), and Managed Care Organizations (MCO) were quite clear.  Not any more!  In fact, they are mostly blurred lines of distinction. 

The projects a Medical Services Professional (MSP) would historically perform would be dependent upon the environment in which they work.  As healthcare continues to shift to a performance-based, outcome driven, budget conscious business – yes, I said business – all healthcare workers are being expected to perform at a higher level, demonstrate competence in broader areas, exhibit innovation in managing their departments and, frankly, do more with less than ever before!  Many of my colleagues are being expected, not asked, to consolidate their departments or integrate other revenue generating service lines.  

One of the leading specialty areas that is proving critical to an organization’s bottom line is expediting the insurance or provider enrollment of their practitioners.  Payor enrollment is now being performed in MSSDs, CVOs and physician practice groups (just to name a few).  There are a growing number of experienced credentialers moving into the specialty of provider enrollment.  These MSPs are joining their enrollment specialist colleagues (those that have been performing this work for many years) to get practitioners/providers enrolled into the various payor plans as quickly as possible, all while navigating the complex world of Federal and State regulations and varying insurance requirements. With eyes focused on this specialty and the increasing employment shifts happening for MSPn that resources were no where to be found. 

As a result, symplr, Team Med Global HealthCare Consulting, and the Texas Society of Medical Service Specialists collaborated to host, produce and present the ONLY global, NAMSS-approved webinar series targeting this very important topic of payor enrollment.  The “Mastering of Payor Enrollment” webinar series is a four-part program serving to introduce experienced and new to the field enrollment specialists, Medical Services Professionals and administrators on enrollment theory, design, challenges and solutions.  

The next session will be held on Wednesday, March 11 at Noon – 1:00 p.m. CST and will address the top 10 payor enrollment challenges and the strategies on how to avoid them.  Click here to register.

Don’t miss this educational opportunity!  You will learn about provider enrollment, how this new information may give you that innovative edge at your organization and how your enhanced competence will increase your career marketability.

Payor Enrollment


Donna Goestenkors

About the Author
Donna Goestenkors

Donna is a full time healthcare consultant, speaker, author, educator, and mentor serving the Medical Staff Services industry for over 40 years. Her diverse project experience includes assignments in every work environment and rapport building among all levels of professional and executive staff. Donna is a past President of NAMSS and her client work covers all of the industry's environments from Healthcare Systems to critical access hospitals.

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