The Revenue Cycle from the Credentialing / Enrollment Specialist View

  • Course level: All Levels
  • Duration 1h
  • Last Update April 29, 2022

Description

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.

Areas Covered in the Session:

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

What Will I Learn?

  • 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

Topics for this course

1 Lessons1h

You can access all the webinar materials after successful payment

Webinar Link + Handouts PDF

About the instructor

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.

Yesenia enjoys spending time with her family and pugs. She finds great joy in jumping in the mini-van for a family road trip.

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5 Courses

20 students

$251.00

Material Includes

  • Handouts PDF
  • Full Webinar Video With Unlimited Access

Requirements

  • Operating System: Windows any version preferably above Windows Vista & Mac any version above OS X 10.6
  • Internet Speed: Preferably above 1 MBPS
  • Headset: Any decent headset and microphone which can be used to talk and hear clearly

Target Audience

  • Credentialing and Enrollment Specialists
  • Credentialing and Enrollment Experts
  • Credentialing and Enrollment Leaders
  • Healthcare Administrative Teams, Personnel
  • 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
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