When Heather Bent sent patient access job descriptions for a market analysis for the first time in six years, she didn’t get the results she was hoping for. “Nothing came back,” she says. “We found out that some of the responsibilities we listed, such as clerical duties, couldn’t be quantified.”

The job descriptions were “completely outdated and very vague,” says Bent, a patient access senior manager at Florida Hospital East Orlando.

Meanwhile, patient access fielded a steady stream of complaints from employees who thought their pay didn’t reflect all the new tasks they were expected to perform. Some left the department for higher-paying positions, either at the hospital or outside the organization.

It became clear the outdated job descriptions were the main obstacle to approving pay increases. Marta Simons, a patient access manager at Florida Hospital East Orlando, explains, “They didn’t truly describe what a person had to do on a daily basis.” The job description for registration representative gave “maintains account accuracy” as an expectation, for instance. “But it didn’t say what the employee was expected to do for the account to be sure it’s accurate,” Simons adds.

Better Analysis Needed

Bent and a patient access director rewrote 10 job descriptions. “We then came back together as a team for the four hospitals. All patient access directors met and agreed on the changes,” she says. The revised job descriptions were submitted and are awaiting approval.

“Meanwhile, we went to HR and asked for recommendations for how we can get a better market analysis,” Bent says.

Bent learned that the first four bullet points become the main focus of the analysis, but the department’s job descriptions listed eight. Expectations were listed in the order they occurred, instead of their importance.

“So all the descriptions listed ‘Greeting’ as the first thing. Obviously, you don’t need to pay people very much to greet people,” Bent explains. “We don’t want that to be what they are comparing us to in the market.”

Another tip from HR: Use different bullet points for lead registration representatives to reflect a focus on team metrics instead of individual metrics.

It was particularly difficult to convey the complexity of the ED registrar role. “It was challenging to communicate just how stressful it can get, and how multitasking plays a big role in this position,” Simons explains.

Another challenge was that patient access had to make its job descriptions consistent across nine hospital campuses. Each campus functions somewhat differently because of varying volumes. “But we are all using the same job description,” Bent notes. “That was very challenging.”

The busiest ED sees more than 400 patients a day, but lists the same job description as a much smaller ED that sees only 60 patients a day, for instance. In addition, there are different expectations for outpatient and ED registrars but were combined into a single job description. This allows outpatient registrars to cover the ED as needed, since the same skill sets are required. “With the new job description, if we don’t have the volume in outpatient, we can float them over [to] the ED,” Bent says.

Even patient access leadership job descriptions needed an update. “They were outdated and somewhat inaccurate,” Bent adds. “We expect a lot more from our leaders than we had on paper.”

Employees remain well informed while anxiously awaiting their hoped-for pay increases. “They were the ones who voiced concerns from the beginning,” Simons notes. “We want to retain them and are keeping them engaged in other ways.”

Patient access staff are encouraged to participate in hospital committees, for instance, and are offered monetary incentives if collection goals are met. “We know pay is a hot topic for them,” Bent says. “We are trying to give them some additional compensation while we’re waiting for approval.”


  • Heather Bent, Patient Access and Guest Services Senior Manager, Florida Hospital East Orlando. Phone: (407) 303-8628. Fax: (407) 303-6764. Email: Heather.Bent@flhosp.org.
  • Marta Simons, Manager, Patient Access, Emergency Department, Florida Hospital East Orlando. Phone: (407) 303-8110, ext. 6560. Email: Marta.Simons@Flhosp.org.

Don’t Set False Expectation for New Patient Hires

Outdated job descriptions set a false expectation for new patient access hires, warns Stacy Hutchison-Neale, CRCR, CHAA, supervisor of the hospital pre-authorization department at Wilmington, DE-based Nemours Alfred I. DuPont Hospital for Children.

Accurate job descriptions “would help associates understand that they are not just answering phones and scheduling appointments,” Hutchison-Neale argues.

People applying for registrar positions might learn that the job includes collecting from patients, for instance — something that is not comfortable for everyone. “It may deter them from applying for a position that does not meet their expectations,” Hutchison-Neale says.

Other applicants don’t realize they’ll need to make a family aware of their out-of-pocket costs or explain insurance coverage and benefits. “I hear quite often that anything pertaining to the insurance is the patient’s responsibility,” Hutchison-Neale says.

Similarly, applicants often assume they don’t have to know specifics about a patient’s insurance to determine if the coverage is active. “Assisting a family and knowing about insurance companies and patient responsibility is everyone’s responsibility,” Hutchison-Neale underscores.

Patient access leaders are trying to create ways to ensure the department’s job descriptions are updated on a regular basis to clearly reflect changing requirements. “Currently, managers and supervisors are notified when mandatory training is needed,” Hutchison-Neale notes. “It would be great to have notifications for annual review of job descriptions.”


  • Stacy Hutchison-Neale, CRCR, CHAA, Supervisor, Hospital Pre-Authorization Department, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE. Phone: (302) 651-5184. Fax: (302) 651-4224. Email: Stacy.HutchisonNeale@nemours.org.