The Revenue Cycle from the Credentialing / Enrollment Specialist View

As the enrollment specialist, you are the connection between in-network and out-of-network claims reimbursement. Understanding the revenue cycle is fundamental for all credentialing and enrollment specialists. You must track the government and commercial (private networks) PAR and Non-PAR funds. If you choose the wrong Medicare participation, you will be unable to get reimbursed. Your choices are a Medicare Participating Provider (PAR) or a Medicare Non-Participating Provider (non-PAR). Contrary to most RCM visuals, did you know that the revenue cycle kicks off at the credentialing & enrollment start line? We will review how our day-to-day work impacts the financial health of our organization. Integrating payer enrollment and credentialing functions continues to gain momentum as consolidation efforts and mergers and acquisitions exponentially increase. Explore the implications of this new frontier, and get up to speed on understanding the big picture and nuances of credentialing and payer enrollment.

Learning Objective

• Implement RCM education for your credentialing and enrollment specialists
• Discuss In-Network vs Out-of-Network reimbursement
• Track the impact credentialing/enrollment has on your RCM

Areas Covered in the Session

• Turn Around Time Reporting
• RCM Visual Review
• RCM Process Review
• CAQH
• PECOS
• Credentialing and Peer Review

Suggested Attendees

• Practice Managers
• Healthcare Billing Specialist
• Staff providing NPI support, NPPES support
• PESC, CPMSM, CPCS
• Staff providing CAQH support
• Clinic Managers
• Allied Health Providers
• Advance Health Practitioner
• Credentialing
• Enrollment
• Office Managers
• Operations
• Revenue Cycle
• Coders
• Clinical Directors
• Practice Owners
• Claims Teams
• MSPs

About the Presenter

Yesenia Servin is an expert in credentialing and provider/payer enrollment with 22 years of experience in the healthcare industry. Yesenia has a deep understanding of Medicare & Medicaid enrollment and is a nationally certified credentialing manager and provider enrollment specialist. Through, YS Credentialing PLLC, Yesenia

• Helps organizations develop and implement best practices guidelines and processes
• Analyzes revenue cycle management
• Guides the credentialing and payer enrollment structure

Yesenia is the payer enrollment lead with TeamMed Global. She manages payer enrollment, keeps team members up to date on industry trends, and is a liaison to all departments that impact payer-enrollment processes. In previous positions, Yesenia has worked with durable medical equipment, hospital and health systems, and community mental health organizations, global managed care organizations as well as providing revenue cycle consulting services to various healthcare providers and organizations.

Yesenia is a current Team Med Global Lead Collaborator, Team Med Global University Faculty, NAMSS member, and is a current and past NAMSS Educational Conference Guest Speaker, a current member of the NAHRI Leadership Council, current trainer for The Chicago School of Professional Psychology and industry trainer. Yesenia studied microeconomics and communications at NEIU and is currently studying healthcare administration at Concordia University Chicago.