Payer Enrollment Island

Finding Your Home on Payer Enrollment Island

By Dina Solis, PESC

 

When I first started in the Payer Enrollment industry almost 20 years ago, I worked for a large, national healthcare provider organization in the San Francisco Bay Area and was charged with my company’s first-ever, official role of managing federal and state enrollments and private payer contracts for 150 provider service locations across the United States. 

I was young, eager to learn, and ready for the challenge! The only problem was, where would I start? Who would train me? Where could I turn for help?

In the early 2000s, educational resources for the enrollment community were nonexistent. There were no books or courses on payer enrollment, contracting processes, or best practices. Like most in our profession, I learned the ropes thanks to old-fashioned trial and error. Over the years, I obtained what my supervisors jokingly referred to as “tribal knowledge” – undocumented know-how that leads to quality work. 

At that time, enrollment struggled to find a home in many healthcare organizations – including mine. Because my role was so specialized, no one knew exactly what to do with me. Even though I single-handedly managed what ultimately contributed to over 80% of my company’s total revenue, I was my own private island with no department to call home.

Over my 11-year career with that company, I bumped around, variously reporting under the umbrellas of reimbursement, executive administration, finance, sales, customer service, contracting, and legal. My final resting spot was in the Compliance Department. That’s a lot of movement for one tiny little island!

I hear similar stories today. Many healthcare organizations still struggle with which department should oversee its payer enrollment function.

If that scenario sounds familiar, you may struggle with being your own private island within your organization. These three tips will help you settle in and find your perfect spot on Payer Enrollment Island.

 

  1. Take ownership of your role. Own your role in having one of the most significant impacts on your organization’s bottom line. For example, if you help manage payer EFT enrollments and your company decides to change banks, insist on being part of that project process. You’ll feel the impact in the form of new or revised EFT agreements and you should have a seat at the table. Show confidence in being the payer EFT expert and that you can get the job done quickly and efficiently.

Similarly, ensure that you’re in the loop with information change procedures. For example, payers typically mandate reporting changes of address within 30 to 60 days, and often require documentation reflecting the new address. This takes time to obtain, so it’s important that enrollment specialists are included in that project team.

  1. Be a leader when working with other departments. Showcase your unique and specialized tribal knowledge by being included in projects that might not fall on your department but can affect your area of work. An example could be a merger or acquisition. M&As are usually run through the finance and legal departments but can greatly affect the enrollment function because of the influx of work they cause. Required reporting to payers includes changes of ownership, new employer identification numbers, and terminating previous owners and providers. If you feel like an island in your organization, use your excellent collaboration skills as a cross-functional liaison.
  1. Use your resources. Thankfully, we now have a wide range of payer enrollment educational resources available at our fingertips. For example, Team Med Global’s Payer Enrollment Institute offers complimentary webinars, thought leadership articles, educational support groups, live presentations, and forums on topics including detailed processes, overcoming common challenges, and best practice tips.

TMG’s Payer Enrollment Institute strives to provide the most current and comprehensive payer enrollment information. If you feel like you’re on your own private island within your organization, claim that spot and find your home by joining TMG’s payer enrollment community! >> Learn more here

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