Stepping Up: 4 Payer Enrollment Management Fundamentals

By Yesenia Servin, CPMSM

Whether you decided to assume the role of payer enrollment manager on your own or you were voluntold to take charge of the payer enrollment team, there are four fundamentals that you should keep top-of-mind.

Payers

First things first. Where is the accurate payer list and does it include effective dates? As a leader, you need to have access to and knowledge of which payers the organization is contracted as INN (in-network) and whether they are delegated agreements. Determine if they are roster submissions or individual provider applications. Learn which are OON (out-of-network) and which are absolutely “do not accept.” Find out if there are CIN (clinically integrated networks) collaborations or other collaborating agreements that require the enrollment team’s attention.

Relationships

Because payer enrollment has a direct impact on the revenue cycle, your stakeholders list is virtually endless. Some relationships will be easy, even effortless; others, not so much. Dig deep within yourself to use (and grow) your emotional intelligence tools. Persist and be patient, specifically when developing a relationship with the contracting and executive teams.

The Team

Your dream team should be your priority. Learn their strengths, roles, and growth areas. Roles must be clearly defined, so write and update them collaboratively. When reviewing goals and recommendations, use Team Med Global’s MSP Core Competence list as your benchmark. 

Education

The more you know, the more effective you’ll be. Join local, government, and private email lists. Register for professional conferences and webinars, and schedule regular trainings for you and your team. Call on your organization’s department experts to share detailed overviews of their roles and remember to make the connection to your payer enrollment team’s work.

When you acquire these four fundamentals early in your management role, you’ll have the core information that will lead to success Congratulations, and enjoy the journey!

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