Profiles in Leadership: John Pastrano Has a Passion for Excellence

2022-07-09T21:50:56+00:00|Profiles in Leadership|

When John Pastrano, CPCS®, CPMSM®, BBA started working part-time in a local Texas hospital’s quality department, he was taking a class to learn a brand-new software program called Excel. The executive secretary in charge of credentialing had a lightbulb moment and asked Pastrano if he could leverage his software knowledge to create a quality profile.

Peers, Coaches, Mentors, Champions: Paving the Way for Success

2022-07-11T15:47:08+00:00|Career Development|

Across the arc of your career, chances are good that you’ve relied on a cheerleader, acted as a cheerleader for someone else, or both. We often group all of those who have supported us into the “mentor” bucket, and those whom we support into the “mentee” bucket. But career-related supporting roles are nuanced, and teasing

Up Your Game with the Provider Enrollment Specialist Certificate

2022-07-11T15:48:53+00:00|Payer Enrollment|

Whether your primary responsibilities are in the realm of payer enrollment or your organization is merging credentialing and payer enrollment functions, it may be time to up your game. The Provider Enrollment Specialist Certificate (PESC) demonstrates your mastery of Centers for Medicare & Medicaid Services (CMS) guidelines and regulations – the minimum requirements for enrollment

Decision-Making Frameworks: A Look Back at the Pandemic Workplace


Living and working through the COVID-19 pandemic left many of us wondering how we managed to succeed in keeping the wheels of the MSD department rolling. New daily information about the virus led to a growing understanding of its implications for our work environments and led to developing new work strategies. Leading teams, departments, and

Delegated Credentialing vs. Shared Services


When I was a newbie, I learned a central lesson about credentialing: that to ensure compliance with the standards, the primary source verification documents I obtained for a practitioner were for my facility only, and peer review information was confidential. That changed when shared services agreements began to take hold. Over the years, four trends

Profiles in Leadership: Relationship-Builder Cris Mobley

2022-07-11T15:55:25+00:00|Profiles in Leadership|

Christine “Cris” Mobley, CPMSM®, CPCS®, draws a direct line from the relationships she’s built to the abundant opportunities presented to her over the course of her flourishing career. Mobley says that she and other pioneers in the medical services professional field – including Carol Cairns, Sue King, and Vicki Searcy – formed early bonds. “We’ve

Profiles in Leadership: Lifelong Learner Karen Reed, Ph.D., CPMSM

2022-07-11T15:58:11+00:00|Profiles in Leadership|

After Karen Reed took an 18-month break from the medical records field following the birth of her second child, the 23-year-old made a bold move: submitting her application to become director of medical records at Community Hospital in Lubbock, Texas. When the hospital contacted her previous employer and noted that Reed didn’t have management experience,

Know Your Strengths: Strategies for Negotiating Managed Care Contracts


The “Introduction to Health Care” textbook (Mitchell & Haroun, p. 502-503) outlines that managed care plans are designed to increase efficiency, cut costs, provide affordable healthcare, ensure quality care, and eliminate waste. In my 20-plus years of reviewing healthcare payer agreements, I have learned to successfully decipher terms and conditions, as well as negotiate on

How Team Med Global Consulting Added Value to PeaceHealth’s MSSD

2022-07-11T16:02:22+00:00|Team Med Global Consulting|

The Client: PeaceHealth Based in Vancouver, Wash., PeaceHealth is a health system serving patients in the Pacific Northwest and Alaska. More than 16,000 caregivers work at ten medical centers and care for patients in urban and rural communities. The Challenge PeaceHealth’s Medical Staff Services Department faced several challenges. Because the department’s had manual processes and

Change Management: How to Navigate “Chance” that Turns to “Challenge”

2022-07-11T16:03:25+00:00|Change Management|

One of my favorite sayings is, “Change is chance.” I have used this mantra in coaching my team through transitions in new software, adapting to new processes, and moving into new offices. Personally, I am in the camp who loves change - most of the time. There are times, though, when change seems less like

Profiles in Leadership: Carole LaPine Has a Commitment to Excellence

2022-07-11T16:07:04+00:00|Profiles in Leadership|

Carole is inducted into the NAMSS Hall of Fame There’s a reason that Carole LaPine, MSA, CPMSM®, CPCS®, was one of the first two MSPs inducted into the NAMSS Hall of Fame. Actually, there are several reasons, all revolving around LaPine’s relentless commitment to excellence. The accolade she received in 2016 was the

Physician Behavior: How to Navigate Reporting a Problem

2022-07-11T16:07:50+00:00|Physician Reporting|

Finding the optimal work-life balance is difficult – even for physicians. Like the rest of us, physicians are human beings with stress, emotions, and life situations that affect their behavior. Over the last several years, physician burnout rates have been a hot topic, and in the past year the world added a pandemic to the

Oh, No! My CEO Wants Us to Participate in Delegated Credentialing


Medical Service Professionals often have Type A personalities. We’re highly organized and proactive – and at times impatient and a bit anxious. It’s understandable that the possibility of losing control over our credentialing process can trigger negative reactions. After all, each hospital and health plan has its own application, its own credentialing process, and its

TMG Unveils Executive Payer Enrollment Professional Competency Model

2022-07-11T16:11:21+00:00|Payer Enrollment|

Team Med Global has unveiled the first-of-its-kind Executive Payer Enrollment Professional Competency Model. According to Team Med Global President Donna Goestenkors, CPMSM®, EMSP, the model reflects the skill sets required of payer enrollment specialists who are at the top of their field. “Executive Payer Enrollment Professionals exhibit the expertise, effectiveness, and impact that deliver value

Dive into the Zone! Join The TMG Zone for Professional Development & Support

2022-07-11T16:13:38+00:00|Career Development|

Whether you’re looking for a quick huddle, a new position, or a way to share your expertise, The TMG Zone is the place to be. Join the TMG Zone on Facebook to connect with MSPs, payer enrollment specialists, practice managers, credentialing specialists, and others who are the gatekeepers of patient safety and revenue. “We designed

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