Provider Enrollment

Critical Skills to Elevate your Role

By Mathieu Gaulin & Jenny Jackson, EdD, MBA, CPMSM, CPCS, FMSP

NAMSS offers multiple educational opportunities to engage and empower Tomorrow’s MSP, including an increased focus on the elevation of the Provider Enrollment Professional (PEP).  As part of the NAMSS Provider Enrollment Education Series, Jenny and Mathieu had the opportunity to share their thoughts on the critical skills a Provider Enrollment Professional should possess. The skills to be a successful PEP are very similar to those needed by any strong, capable MSP: good communicator, strong organizational skills, refined attention to detail, inquisitive character, structured process orientation, and true grit. These skills ensure an effective path to success as an MSP, PEP, or ideally, both! Too often, however, our PEP colleagues are in the background, performing critical work that often goes unnoticed. Our goal with this article is to bring PEPs out of the background to thrive in the foreground. There is no better time to use the skills PEPs have refined over the years to expand your scope, knowledge, and value. We would propose that regardless of your role as an MSP, PEP, or both, these invaluable skills are critical on your career trajectory as a liaison, an expectation manager, an advocate/champion, and a networker.

Critical Skill 1: Liaison

Facilitates close working relationships between people or organizations

It is essential that PEPs understand and acknowledge key stakeholders, what drives them, what they need from you, and how you can get what you need from them most effectively. To begin, we recommend visualizing yourself in the center of a connected group of stakeholders. An effective PEP impacts a broader set of stakeholders than you may realize. Have you assessed your stakeholders lately? You probably know who is most immediately impacted by your work, but have you thought more broadly? What about the government relations group, or the managed care contracting team, or leadership in the physician organization? Do they know what you do for the organization and how your work impacts their operations? Take it upon yourself to share your process liberally but also learn about their workflows. Anything you can do to help make their process easier will increase your effectiveness and make your  process better. Make time to objectively review your processes along with any direct or indirect processes.  Ask yourself: What’s working well? Where are you or they getting stuck? What could be done differently?

An effective PEP will not only critically assess other’s work but also their own. Don’t hesitate to reach out and make process connections and recommend improvements. Because provider enrollment has multiple downstream implications in an organization, opportunities for improvement are significant. Also, taking a break from file processing is good for the soul, the mind, and the work in general. To thrive in the foreground, you will be at the helm of your team (immediate and on a broad level), steering them to a successful outcome, whether that is effective primary source verification processing, an efficient approval process, or expedient enrollment with the payers. To be in control of your process, you must appreciate your impact on other stakeholders and the organization as a whole.

Critical Skill 2: Expectation Manager

“There is no one right way, but there is always a way to make your way more effective!”

This should be the motto of anyone who wants to develop and improve their process, their team, and their career because there is always room for improvement. Now that you have identified your key stakeholders, learned about their processes, shared your own processes, and formed crucial relationships, you should consider how to collaborate on realistic expectations. We all know that the credentialing and enrollment processes can be perceived as a frustrating barrier to many, but you have an opportunity as a PEP to ensure stakeholders appreciate your role in protecting patient safety. This starts by managing your own expectations. Make sure you know your metrics, how they are impacted by time of year and/or volume, and what factors can increase or decrease those metrics. Communicate, communicate, communicate! Remember to build in time for those unexpected but inevitable emergencies.  Then you can begin to manage your provider’s expectations, ensuring they understand all parts of the process. But don’t forget about your colleagues! Unless you are educating them, your colleagues aren’t thinking about the extra time needed to enroll providers in health plans. We all have the same objective: when can the provider start seeing patients and when can the organization bill and be paid for those services? To thrive in the foreground, you must learn to under-promise and over-deliver by managing your own expectations of reality. Failure to build cushion time into your proposed timeline may set you up to manage disappointment if something unexpected should occur. However, it will make you look like the pro you are if everything is firing on all cylinders!

 

 

Critical Skill 3: Advocate & Champion

To thrive in the foreground, you must be a strong, passionate advocate for your profession both internally within your organization and externally to the provider enrollment industry as a whole. Provider enrollment is a niche market and experienced PEPs are in high demand. That is why Jenny and Mathieu are writing this article, we are advocating and championing for you! Will you be the next voice for PEPs? If you haven’t thought about it, you should. This will help to elevate you and can provide opportunities to break out of the monotonous, but exceedingly important, day-to-day, and bring you a newfound reinvigoration and passion. “See one, do one, teach one”, works for clinical professionals and can also work for provider enrollment professionals! This is where you may need to push yourself out of your comfort zone and come out of the shadows. It is easy for others to overlook the work of provider enrollment, especially when it is working well. However, we know the painstaking work that is going on behind the scenes.  Set aside time to connect with your stakeholders, liaise with them, champion your process and theirs, and then seek to improve. Ask yourself: Have you met with the Chief of your largest clinical department lately to ask how it’s going or to offer kudos or feedback to their team? If not, you should! To thrive in the foreground, you have to change your way of thinking, know your value, be open to change and have the courage to take a risk.  Your success adds value to your organization and your failure is simply a temporary setback and learning opportunity.

 

 

 

 

Critical Skill 4: Networker

Sometimes being an MSP or PEP can feel like an individual or small team sport, but it doesn’t have to be. Remember that we are a network of supportive professionals, each with our own ideas that can be built upon and adapted to continually improve processes. Build out your networks, get involved with your local and regional organizations, and connect with colleagues in similar roles at neighboring organizations. Professional networking produces opportunities to ask questions of your peers, share your own processes, and learn from each other. Additionally, NAMSS is a great resource, as are your state organizations, Facebook and LinkedIn groups. Other suggestions include: starting a distribution list of like-minded colleagues or setting up a monthly zoom or lunch (when feasible). Again, the mind does better when challenged. Taking the time for networking activities will lead to collaborative brainstorming and process improvement. With the increase in digital communication platforms, the opportunities to learn and grow with colleagues are endless. Ask yourself: Have you created an Affinity Group or User Group for your local area so that you can share best practices? Find out if there are any groups in your local area and if not, consider starting one. Browse for groups and pages on Facebook or LinkedIn, reach out, and be that advocate connector. People will appreciate you and your visibility will rise to the foreground!

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Jenny and Mathieu are passionate advocates for the elevation of the provider enrollment professional. We are so excited to be a part of the NAMSS mission in guiding Tomorrow’s MSP. We are here to advocate for you, champion for your work, network with you, and help you on the path to success so that you are the next person writing for NAMSS Gateway or presenting at the National Conference! You have a lot to offer! Will you thrive in the foreground?