Hiring for Effective Post Service Revenue Cycle Performance

There are a number of staffing strategies business offices should consider when experienced candidates are scarce.

During a recent HFMA Forum listserv discussion, members shared frustrations with the scarcity of experienced candidates for revenue cycle positions and shared insights on how they select the right people for positions and bridge the knowledge gap.

Experience in Short Supply

“We continually have trouble finding strong candidates to fill roles in our back-end business office. Many applicants have no knowledge of the back end or its terminology,” wrote Michael J. Poolos, CPA, director of finance, The Hospital at Westlake Medical Center, Austin, Texas. “Because 90 percent of applicants have experience in physician practices, but not hospitals, we’ve taken a chance on a few of them. Unfortunately, it has not always worked out.”

Another Forum member from rural Ohio expressed similar frustration with finding qualified individuals. She recently filled a Medicare billing position with an internal candidate from the hospital’s registration department. Although the internal candidate had no post-service experience, management believed her positive attitude would allow her to gain the necessary technical knowledge quickly.

Nate Seaman, a Houston-based healthcare director at Huron Healthcare, offered advice to people who want to hire from within. “I agree that attitude is critically important. If you have strong processes, you can develop people’s industry expertise. Whether outside applicants are plentiful or in short supply, it always makes sense to maximize the potential of existing employees. Facilities can evaluate their internal processes to make sure they are doing so.”

A long-term commitment to employee development can help facilities overcome many limitations, including a dearth of outside job applicants, according to Seaman. “I’ve worked with a number of clients in markets with small populations and few applicants. They were able to operate successful revenue cycle departments by focusing on employee engagement, developing internal resources through productivity and quality monitoring, and achieving best practice training guidelines. They also focused on making staffing decisions based on the true financial impact of a unit adding or losing employees, rather than based on historial design. For example, it’s understood that fiscally it makes sense to have front-end and back-end staff work the high-dollar accounts as well as have a small-balance adjustment policy in place. However, the higher-performing staffing models have a better sense of which dollar tiers of accounts should be worked internally, which accounts should be outsourced to vendors, and which accounts should be addressed with small-balance adjustments.”

Success in the First 90 Days

There was consensus among the HFMA Forum members involved in the discussion that the right candidates can overcome a lack of post-service knowledge and experience to become valuable employees. With inexperienced candidates, the first 90-day training period is critical. Forum members commented on what new hires should learn during the first three months on the job to instill confidence and maintain employee enthusiasm.

Jason Metcalf, director of revenue cycle services, Yavapai Regional Medical Center, Prescott, Ariz., emphasized that the first training priority must be cash flow.

“One critical issue in the first 90 days is to ensure the employee knows how to handle Medicare and the DDE [Direct Data Entry] system. Most other payers base their policies on Medicare, and these claims have the most compliance billing risks. In addition, they work very differently in hospitals compared with physician practice settings, so hires coming from physician practices need additional training. Chargemaster maintenance is key as well. New staff also should monitor DNFB [discharge not final billed] and understand your claim scrubber, the clearinghouse for Medicare 837I claims,” Metcalf explained. “A staff that can bill correctly and cover these tasks will capture most of your cash. They can learn the rest along the way.”

Seaman added that by creating the right environment for new staff, more new hires will make it past the 90-day mark. “Evaluate the training plan for new revenue employees to ensure it is adequate to turn a good candidate with minimal experience into a successful hire. Also, ensure the role has a detailed description of expectations, as well as a matrix of daily and weekly responsibilities that managers can review with applicants. By taking these steps, you can not only train your next hire, but also create a pathway for maintaining skilled back-end revenue staff.”

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Interviewed for this article:

Michael J. Poolos, CPA, is director of finance, The Hospital at Westlake Medical Center, Austin, Texas, and a member of HFMA’s South Texas Chapter.

Nate Seaman is healthcare director, Huron Healthcare, Houston, and a member of HFMA’s First Illinois Chapter.

Jason Metcalf is director of revenue cycle services, Yavapai Regional Medical Center, Prescott, Ariz., and a member of HFMA’s Arizona Chapter.