Leadership

Provider Enrollment in the Medical Staff Office

By Karen Claxton, CPCS, CPMSM, FMSP and Betty Blalock, CPCS

In our organization, provider enrollment evolved from each practice changing their own enrollment process into a more centralized specialist one for the employed practitioners. The duplication of requests became evident early on, and a meeting was called to coordinate processes and decrease duplication. The medical staff office team, recruitment, the provider enrollment specialist and the human resources (HR) team attended. A coordinated process was developed to improve the customer service we provided to the practitioners and decrease duplication. 

The medical staff office would drive the process and pass on information provided by the applicant to provider enrollment and HR with a signed release by the applicant. Information shared included demographics, license, certificates, curriculum vitae, etc. References and verifications were not shared outside of the medical staff office (MSO). This process worked well, but communication between the departments was not always optimal. The provider enrollment specialist would occasionally jump ahead resulting in duplicate requests. 

In 2018, the provider enrollment specialist submitted her resignation, which resulted in the discussion of moving the process to the MSO. A job description was developed and a request for the position was submitted. After several weeks and a few interviews, we discovered finding an experienced enrollment specialist in our rural area would be difficult. The salary was not high enough to warrant someone experienced moving to the area to accept the position. At that time, a long time MSO team member, Betty Blalock, CPCS, offered to learn provider enrollment, and we decided backfill her position which was responsible for reappointments. Training a new person to do reappointments seemed easier than training someone new to do provider enrollment.  Betty immediately located a mentor in another town, we searched for conferences and joined some groups to learn what we could about provider enrollment. What we wouldn’t have given to have access to the new NAMSS offering on Provider Enrollment back in 2018! 

Betty asked a lot of questions, and some aspects she learned by trial and error, but she kept at it. In time, she started speaking in provider enrollment code with a whole new set of acronyms.  With provider enrollment in the MSO office, communication was at its best. Betty had access to all the information needed as soon as it was received in the MSO. She already understood the confidentiality of the information received during the credentialing process. She often was able to identify “missed” affiliations on an application by comparing it to the provider’s Council for Affordable Quality Healthcare (CAQH) profile. Physician satisfaction with the onboarding process increased.

Having access to the provider’s contact information was beneficial in timely requesting and obtaining signatures for the enrollment applications. Understanding the credentialing process and documents such as state license, DEA and NPI helped make the transition from hospital credentialing to provider enrollment easier. 

Working within the MSO, Betty knew in advance when new providers were in the onboarding process and the expected start date. She was aware of locum tenens scheduled to cover for employed physicians and if providers would require insurance enrollment. Betty was also one of the first to know about changes in the provider’s demographics, when a practice moved to a new location or when a provider was no longer employed, which was beneficial in maintaining physician rosters and the credentialing databases.  

Close communication with recruitment, billing and practice managers helped to keep everyone up to date with the status of insurance enrollments. Having access to credentialing information and documents enabled Betty to maintain CAQH profiles in a timely fashion. 

As a credentialing specialist in the medical staff office, Betty developed important skills that were transferrable to her new position as provider enrollment specialist. As identified by NAMSS in defining Tomorrow’s MSP, our roles are changing and our functions are being centralized. As MSPs, we must innovate, be willing to adapt to new responsibilities and expand our knowledge and skills. If we don’t, we will get left behind.