Former U.S. Secretary of Defense Donald Rumsfeld famously mused, “There are known unknowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But there are also unknown unknowns. There are things we don’t know, we don’t know.”
Strategic planning builds on the strengths of an organization and tries to repair the weaknesses that makes it vulnerable in its marketplace. Strategic planners try to avoid the unknown unknowns. This presentation will demonstrate that improper management of the credentialing, privileging and enrollment process has been proven to be a costly oversight for many organizations. Fragmented and inefficient credentialing, privileging and enrollment processes create compliance risks, barriers to care and claim denials. This process should be reviewed annually and included in every healthcare organization’s annual business planning process and enterprise risk assessment.
Nancy Rosenthal, Susan Prior & Regina Alexander
Nancy Levitt Rosenthal, FACHE, MPH is President of the NLRGroup. A graduate of the University of Michigan’s School of Public Health, her career has included working for a national consulting firm and for several large health systems, community hospitals, and a community mental health center in the Midwest and Northeast. Her areas of expertise include strategic planning, marketing, physician relations and business development. She is on the Board of the Connecticut Chapter of the American College of Healthcare Executives (ACHE) and served as its former President and Regent for Connecticut.
Susan Prior, CHC is President & Chief Operating Officer of VantagePoint HealthCare Advisors. A graduate of the University of Connecticut, she serves on the Board of the Connecticut chapters of HFMA and ACHE. Ms. Prior’s area of subject matter expertise include regulatory compliance, physician compensation, strategic and financial planning. She is responsible for VantagePoint’s daily operations, including credentialing, enrollment and primary source verification(PSV) services.
Regina K. Alexander, FACHE, CHC serves as a Senior Consultant at VantagePoint. Ms. Alexander is a board-certified fellow (FACHE) in healthcare management through ACHE and holds an MBA from The George Washington University. Prior to joining VantagePoint in 2017, her most recent prior roles included Director of Health Information Management (HIM) and Privacy Officer for a community hospital, Associate Director of HIM for a large health system, and Senior Product Manager/Medicare Advantage for a regional health plan. Her areas of expertise include Medicare and Medicaid payment policy, regulatory compliance, HIPAA, revenue cycle management, and rapid-cycle process improvement.