2006 Salary Survey Results

Access professionals are getting their due as front-end expertise more often sought for top-level positions

Silos continue to disappear 'in all aspects of the revenue cycle'

Long gone are the days when access services took a back seat to the business office or patient accounting. At least when it comes to director-level positions, industry sources tell Hospital Access Management, access expertise is highly sought after and valued by health care organizations seeking to shore up their revenue cycle teams.

"It's one of the better [fields] to be in," says Carolyn Milburn, president of Milburn Partners Inc., an executive search firm that specializes specifically in revenue cycle positions. "You have more options to take your career to different areas because [access knowledge] is so needed."

Milburn's firm is working to fill a divisional revenue cycle director position for a national hospital chain, she adds, and "the target is that the candidate comes with strong access experience in order to complement the other people in divisional roles."

"This is a major for-profit system with 48 hospitals, and [leadership wants] a person to be the access expert to the business office or revenue people on the team," Milburn explains. "While they're not calling it an access specialist, that [function] has been strongly emphasized in the organization."

Typically, someone with only business office experience would have been hired for a divisional position, she adds, "but they want someone strong on access who may have touched the back end, because they need that expertise."

The person ultimately hired for the position will be a peer to others on the revenue cycle team, she says, and a salary of $125,000 is being offered.

Strong customer service skills, among other things, set access professionals apart from their colleagues in other parts of the revenue cycle, Milburn says.

"Many of these organizations are opening hospitals to be like hotels, so they're looking for that high-energy personality," she adds, as well as financial acumen. "That's a hard combination to find.

"The back-end [managers are] used to going through numbers and finding the errors," Milburn notes. "The front-end people are more social and want to be more involved in processes. In my opinion, they're better at accepting change."

One job candidate Milburn has worked with completed an administrative fellowship in health care and has a strong customer service background and training experience, she says. "He is now targeting the access services field for his career because of his customer service focus. He's thinking that area needs attention."

Her firm recently placed a person at the director level, with access responsibility for the hospital service line, at a large nonprofit health system with an academic medical environment, Milburn says. The system, located in the Southeast, includes five hospitals and 21 physician clinics, she adds. Because of the complexity of the position, Milburn notes, the director level there is comparable to a regional role in other health care organizations.

The salary was $150,000, which drew an, "Oh, my gosh" from the system's chief executive officer and chief operating officer, Milburn recalls. "I think that [figure] was getting close to their level."

A similar position at that system, which is located in the Southeast, has responsibility for outpatient access and scheduling, with a salary of $125,000, she says.

Specialized access skills, such as experience with a call center, can make a candidate particularly attractive, Milburn points out.

"We've worked on a lot of call center positions," she says. "A gentleman in Atlanta, who was highly regarded, was hired as director of a call center at $90,000, and we placed another call center director at $82,000."

Both individuals had just two to three years' call center experience, preceded by the same amount of time in accounts receivable, Milburn notes, but the combination of the two areas was a big draw.

Based on data compiled by her firm from a group of 148 professionals with director-level experience in access services, she says, those with one to three years' experience have an average salary of $69,500, while for those with four-plus years of experience the average figure is $83,800.

Salaries for access managers, meanwhile, average $60,000 with one to three years' experience, and $73,300 for four-plus years of experience, adds Milburn. The candidate pool used, she notes, consists of individuals employed by nonprofit and for-profit hospital systems across the country.

Breaking down the figures according to region and profit status, Milburn says, her data indicate salaries are higher in the Northeast and the West, compared to other regions of the country, and at for-profit systems.

Higher salaries 'an investment'

Silos are disappearing in patient access, patient accounting, and medical records — all aspects of the revenue cycle, notes Vickers Chambless, with Vickers Chambless Managed Search in Atlanta. "That trend has been going on for a while, and it's more and more pronounced this year."

Meanwhile, salaries are up for director- and vice president-level revenue cycle posts in competitive hospitals, Chambless says. "Salaries for [those positions] are increasing because that's where the increase in hospital revenue is. It's an investment, having people who are better at that.

"Well-informed providers," he adds, "recognize that they are competing for revenue cycle talent whether they are located in towns of 300,000 or in metropolitan Los Angeles."

Those who aren't as well informed will catch on eventually, Chambless says. "I still get calls from hospitals with less competitive salary ranges, that don't have an awareness of what's going on. If I say [they should offer] $10,000 to $12,000 more, they need independent verification. Usually that verification is when one of their employees is recruited away."

Chambless says he recently spoke to a vice president of revenue cycle who told him that if the chief financial officer would accept his recommendation on an initiative that would cost $22,000, there would be a return of $750,000 a month.

"What will happen if that CFO doesn't accept is that well-informed employee will leave," he adds.

Salaries at the manager level are static now, but that could change, Chambless says. "In 2007, there will be fewer facilities with a less competitive outlook because they can't attract people and people will be stolen from them. And the next year, in my opinion, there will be fewer still."

Those seeking advancement in the revenue cycle arena, on the other hand, "have got to be able to relate to the person senior to them," Chambless advises, "and that becomes an accountant. An access manager or director may not report [directly] to a CFO, but maybe to a revenue cycle VP who reports to a CFO. So ultimately they are reporting to an accountant."

With that in mind, he suggests pursuing business or accounting degrees rather than liberal arts. Those are best earned in the conventional way — not on-line, Chambless adds.

Those who, like in the example above, are arguing for progressive initiatives, should consider becoming involved with professional organizations, he says. "Attending conferences, like [those offered by] the Healthcare Financial Management Association, makes you better able to lobby to get the things you need. It gives you more ammunition to argue with."

Survey breakdown

Access professionals responding to Hospital Access Management's 2006 Salary Survey reported gross incomes that ran the gamut — from $30,000 to $130,000 — with just a percentage or two falling outside either end of that range.

Most respondents (46.5%) said they made somewhere between $40,000 and $69,999, and the next heaviest grouping (23%) fell between $70,000 and $89,999.

About 8% reported incomes of between $90,000 and $99,999, and just under 10% said they made between $100,000 and $129,999. On the other end of the scale, 9% had incomes of between $30,000 and $39,999.

The great majority of survey respondents said their salaries went up in the past year, with most receiving a 1% to 3% increase (54.5%) or 4% to 6% increase (20.5%). Another 9% got a raise of between 7% and 10%, and 8% said there was no change in their compensation.

A few people reported substantial raises, including 4.5% who said they received an increase of between 11% and 15% and just under 2% who got an increase of between 16% and 20%.

The most commonly selected job title — of five choices — was director, access management (33%), followed closely by access manager (28.5%). The next highest number (27%) chose the "other" category and listed a variety of similar, access-related titles.

Those included titles that were virtually the same as the stated categories, such as patient access director; director of registration; manager, patient access services; access & staffing manager; registration & scheduling manager; and admitting manager.

Also listed in the "other" category were some titles that suggested broader or different responsibilities, such as patient financial services director; business office manager; director of patient accounting; director, health information management/patient access; and senior director, access services/chief privacy officer.

A few respondents gave their title as revenue cycle director, reflecting an apparent industry trend toward a more comprehensive approach to patient finance.

Asked to give their highest academic degree, 8.5% of respondents chose "diploma (3-year)," 7.6% selected ADN, 6.7% selected MSA, and 5.7% chose BSN.

More than 70%, however, chose the "other" category, and mentioned a variety of degrees, including a few MBAs and other master's degrees, and several bachelor's degrees. For about a fourth of that 70% of respondents, a high school diploma was the highest degree obtained.

As usual, the vast majority of respondents work for hospitals (93.4%) and "non-profit" (87%) best describes the ownership of their employer. A little more than 6% work for a for-profit organization, less than 1% said they were employed by a college or university, and 5.45% work for state, county or city government.

More respondents said they work in facilities in rural areas (33.6%) than in medium-sized cities (27%), urban areas (21.5%) or suburban areas (18%).

Most of those taking the 2006 survey, about 66%, were between 46 and 60 years of age, with the heaviest concentration (32%) between ages 46 and 50.

The gender gap continues, according to the latest survey, with women representing 81% of respondents.