Ochsner’s Revenue Cycle Fellowship: An Investment in the Future

A Louisiana health system’s fellowship program prepares future leaders for the challenges of the revenue cycle environment.

The continual flux of payment and regulatory rules in health care has highlighted the importance of revenue cycle operations and its need for sharp, expert leaders. In 2015, Ochsner Health System, a not-for-profit health system serving southeast Louisiana, met this new challenge by launching a revenue cycle fellowship program. The effort was the latest in Ochsner’s series of fellowship programs; similar programs in operations and finance date back to 1971 and 2009. respectively. The two-year revenue cycle fellowship is designed to impart a vast amount of revenue cycle knowledge in conjunction with an overall understanding of finance and operations in a short time.

Identifying and Placing a Successful Candidate

The goal of the Ochsner’s fellowship program is to identify and prepare future healthcare leaders. A good candidate possesses interests and a background aligned with organizational needs. Key among these needs is the candidate’s fit with the organization’s values and mission. The interview process consists of three stages: application review, phone interviews, and on-site interviews.

The application review . To apply for the program, an applicant must submit a resume, three letters of reference, a one-page personal statement, and a graduate school transcript. It is preferred that applicants have obtained a master’s degree in a field related to their fellowship. Each application is reviewed and scored by a committee of current fellows and preceptors. For its first two cycles, the selection process for the revenue cycle fellow was done in conjunction with the selection of the finance fellow. Going forward, the processes will be separate and include a committee of former and current revenue cycle fellows, the revenue cycle preceptor, and a representative from human resources.

Phone interview . Candidates identified by the application committee undergo initial phone interviews to gauge their interest in Ochsner and a career in the revenue cycle and to answer questions regarding their applications. Approximately 20 applicants are selected to participate in these interviews based on scores given by the selection committee.

On-site interview . Candidates that advance to this third stage undergo a day-long process consisting of conversations with senior leaders and former and current fellows. Approximately 10 to 12 candidates are invited to this event, where they are split into groups and given a timed case study, which they later present to a panel of Ochsner leadership and current fellows. This portion of the process allows the interview panel to assess each candidate’s presentation skills, ability to work as part of a team, and capability under stress. The selection committee provides input on various key areas, and the preceptor makes the final decision, taking that feedback into consideration. The collaboration and feedback process is important not only for helping to identify the best candidate but also for providing current fellows with an opportunity to gain valuable interview and hiring skills, which they will use as future leaders.

Program Structure

Ochsner’s Revenue Cycle Fellowship consists of four key structural components: mentorship, rotations, projects, and leadership development.

Mentorship . Mentorship is the backbone of Ochsner’s fellowship program. Leaders at all levels of the organization are deeply invested in the fellows, and fellows build lasting relationships with management and peer fellowship members.

Each revenue cycle fellow is assigned an executive preceptor who guides the fellow over the course of the fellowship. The preceptor is vital to the fellow’s success, meeting regularly with the fellow to answer questions, provide feedback, and offer guidance based on his or her experience and knowledge. This commitment from senior level leadership enables the fellow to see his or her value to the team and to feel qualified in providing insight or assistance when rotating through different areas.

Fellows in each of Ochsner’s fellowship programs also are assigned mentors among peers who are former fellows, not necessarily from their area of concentration. For example, a revenue cycle fellow may be paired with a mentor who was a fellow in the finance fellowship. These former fellowship participants provide unique insight based on their experience. Pairing fellows across concentrations fosters a diverse perspective on the healthcare issues each participant will undoubtedly face throughout his or her career.

Rotations . The first of the two program years focuses on defined rotations in finance and revenue cycle to give participants an overview of the organization. During a three-week orientation, the fellow travels to various Ochsner’s facilities and meets with the executive teams and with system leaders and departments. After orientation, the revenue cycle and finance fellows start a series of about eight rotations in various areas of operations, beginning with a three- to four-month rotation with decision support, where they learn about Ochsner’s financial metrics, reporting tools, and internal terminology, which will serve as a foundation for the rest of the program. This rotation also provides the fellows with the opportunity to assist the department with report requests from various areas throughout the organization.

The last set of rotations carries the fellow through the entire revenue cycle division. This hands-on approach allows the fellow to shadow employees at both the staff and management levels and to sit in on weekly meetings with the revenue cycle executive team, thereby  gaining a high-level overview of each area’s function, and the ability to see how each area affects one another at a high level.

Other than the initial rotation with decision support, each rotation lasts anywhere between three and six weeks, and the number of hours devoted each week depends on both the needs of the department and the fellow’s interest. For example, a fellow with an interest in patient access may choose to spend more time in this rotation or even extend the rotation.

Projects . The fellowship’s second year allows fellows to narrow their interests based on their previous rotations.  Fellows participate and even lead projects to build their skill set and network within Ochsner. Project time varies in length, and most fellows are involved in more than one project at a time. This practice allows fellows to work with people throughout the organization and delivers another level of exposure. For example, projects completed in the inaugural fellowship included completing an ROI analysis of computer assisted coding, developing a business case for bringing on a partner hospital as a client, and building a productivity dashboard for the professional coding department.

Leadership development . The core purpose of the fellowship program is leadership development, which occurs in several different arenas. A fellow has the opportunity to observe and participate in various senior leadership meetings such as monthly operating reviews, executive retreats, and strategic planning sessions. These experiences allow fellows to view the organizational leaders in action and become familiar with the organization’s strategies, challenges, and opportunities.

The revenue cycle fellow also attends Lean training and obtains Lean Six Sigma Green Belt Certification. Lean Six Sigma is a project management methodology that focuses on improving processes, reducing waste, and enhancing customer experience. Ochsner’s Lean training provides fellows useful tools and techniques to identify stakeholders that are part of a revenue cycle process, measure and analyze process performance, eliminate waste in the process, and sustain the improvements. Through monthly training with the human resources department, the fellow practices simulated leadership scenarios such as conducting interviews with potential employees, having difficult conversations regarding personnel issues, and providing feedback. The fellow’s training is rounded out with online and in-person training on topics such as leading change, facilitation and presentation skills, and software skills.

Throughout the fellowship, fellows submit quarterly updates to senior leadership and their preceptors regarding their personal development plans, projects, and career goals. This reporting process helps e fellows maintain their momentum and ensures the program is accomplishing its goal of preparing fellows for leadership roles. Ochsner’s first revenue cycle fellow now works for the health system as manager of documentation excellence.

Flexible Structure

A successful fellowship program must have structure but at the same time be flexible. An outlined rotation schedule ensures each fellow achieves the appropriate learning objectives. But fellows also are able to mold their experience based on their career interests and the organization’s needs, which helps ensure they are fully engaged in and committed to the program.

Fellows must be willing to put in the time and energy necessary to grow and have the confidence to ask questions, provide feedback, and actively pursue the projects they’re passionate about. Likewise, leadership must create a web of support that enables fellows to provide the value they’re capable of bringing to the organization. Fellows are the future leaders of the healthcare industry. Dedication is key to ensuring an investment in these future leaders meets its full potential.

Katherine Cardwell is assistant vice president at Ochsner Health System, New Orleans, La.

Brittainy McKinney is manager of documentation excellence at Ochsner Health System, New Orleans, La., and was the first revenue cycle fellow at Ochsner Health System.