Executive Summary

Cross-training registrars improves patient satisfaction with shorter waits and improves employee satisfaction with opportunities to advance.

  • Include cross-training requirements in career ladders.
  • Ask prospective candidates if they are interested in cross-training.
  • Choose employees who are enthusiastic about cross-training.

Cross-training is critical to the success of many patient access departments.

“My team floats around, often filling in for areas that are down in staffing,” reports Kim Rice, MHA, director of patient access at Shasta Regional Medical Center in Redding, CA.

If a registrar calls in sick, for instance, an outpatient scheduler can step in to register patients. “Once the staff get caught up, the scheduler will go back to scheduling,” says Rice.

The same approach is used during sudden volume surges. “Even when the department is fully staffed, I will pull someone from another position and have them register,” says Rice. “This keeps the patient flow moving.”

Very Different Flow

Scheduling is done the same way, in the same system, regardless of the registration area. Jobs differ in other important ways, however. Radiology and perioperative are both registration roles, for instance, with very little scheduling involved. “But the flow of what happens is very different,” says Marion Knott, manager of clinic access at Tampa, FL-based Moffitt Cancer Center.

Both areas need to get all the necessary forms completed, but these differ depending on why the patient is there. Although radiology enters clinical information into a separate system for patients who leave after the procedure is completed, the perioperative floor deals with patients who are being admitted.

“Very different information is needed than with an outpatient appointment,” says Knott. For example, Medicare patients complete a form outlining their rights as an inpatient.

Finding a pool of well-trained registrars who understand these nuances is not easy. It begins with two weeks of classroom training given to all new hires. This covers all aspects of registration and scheduling — but only for the area for which registrar the was hired.

“When they come out of training, they spend a couple of days observing at the clinic they’re going to work in,” says Knott. Working with a peer allows employees to fine-tune their registration and scheduling skills.

“This gets them fully acclimated to the area they’re hired for,” says Knott. “Then, if they’re interested, we trade them off to other supervisors to learn other areas.”

This is an integral part of the department’s career ladder. “Everybody comes in at a Level 1,” explains Knott. To get to Level 2, employees must be cross-trained for all of their supervisor’s areas. Level 3 requires even more cross-training in another supervisor’s area. (See the department’s eligibility requirements in this issue.)

New patient access team members all start out as “Level 1s” at Moffitt Cancer Center in Tampa, FL. “After six months on the job, they can apply for advancement,” says Marion Knott, manager of clinic access. Below are the eligibility requirements for a patient service or financial clearance specialist:

1. The employee must meet or exceed standards on the most recent performance evaluation.

2. The employee must consistently follow all policies, clinic and revenue cycle guidelines, and the Code of Ethics and Professional Conduct, as evidenced by the lack of any disciplinary action or written counseling in the preceding six months (does not include documented coaching or documented verbal counseling).

The following steps are used if employees wish to be considered for advancement:

1. Team members must submit a form documenting their attainment of the requirements and a form demonstrating maintenance of the requirements. The forms are due during the first application window after the team member has had 24 months at the current level. If these team members do not submit documentation during the application window following 24 months at an advanced level, they will be re-leveled as a “1.”

2. Two application windows are offered each year: one in the fall, and one in the spring. Applications are available from supervisors or managers. Applications are reviewed by the director, manager, and supervisor to ensure consistency. A decision is communicated to the team member within one month of the application.

3. Team members can request a voluntary movement down the ladder at any time because of an inability to meet expectations or personal preference.

“Each promotion gives them a merit increase,” says Knott. “This encourages them to be proactive with their learning.”

Knott, who started out years ago as a patient access representative, is an advocate of cross-training based on personal experience. “I was the one always chosen to ‘go float.’ The experience from doing that years ago helps me today,” she says. If a clinic reaches out for help because a supervisor is unexpectedly out or overwhelmed, Knott can be counted on to cover for him or her.

The group of cross-trained registrars has a big advantage when it comes to career advancement. Many have taken on different jobs in patient access.

These opportunities are highlighted at the department’s annual “town hall” meeting, which educates employees on all of the various paths to advancement within the revenue cycle.

“The people who want to grow, do grow,” says Knott. “Many have moved on to roles in training, escalation, financial clearance, or the call center.”

Help, From a Distance

Cross-training has helped patient access to fill unexpected staffing gaps many times. Recently, all of a clinic’s providers were away at the same conference, so no orders were coming in and staff had little to do. Another clinic was overwhelmed and asked for help. Sometimes, registrars can stay at their physical locations while helping out. “They can help each other at a distance, since all orders come across electronically,” Knott explains.

Cross-training also helped during Hurricane Irma. Even though the storm was not expected to make landfall in the Tampa Bay area until Sunday night, many staff members evacuated as early as Thursday night. “We were still open until Saturday,” says Knott. “Because we had so many team members cross-trained, we were able to provide coverage in all clinics.”

The following are strategies for successful cross-training:

  • Carefully choose which employees to cross-train.

At Hackensack Meridian Health — Palisades Medical Center in North Bergen, NJ, patient access leaders evaluate employees’ performance and productivity. They identify those with the “right stuff” to be cross-trained.

Not all employees are suited for this. “It all depends on their demeanor, strengths, and overall performance,” says patient access director Maria Lopes-Tyburczy, CHFP.

Cross-training employees takes time and money, but departments report a trickle-down effect: Patients are happier. “Better patient throughput in registration areas, in turn, improves the overall patient experience,” explains Lopes-Tyburczy.

Good decisions on which registrars to cross-train means a good return on the investment. “If they retain what they’ve learned and are available when needed, it can be cost-effective in the long run,” says Lopes-Tyburczy.

  • Ask potential new hires if they’re interested in cross-training.

This sends a strong message that there’s opportunity for advancement, says Rice. “Usually, this sparks their interest in the position even more.”


  • Marion Knott, Manager, Clinic Access, Moffitt Cancer Center, Tampa, FL. Phone: (813) 745-3239. Email: Marion.Knott@Moffitt.org.
  • Maria Lopes-Tyburczy, CHFP, Director, Patient Access, Hackensack Meridian Health — Palisades Medical Center, North Bergen, NJ. Phone: (201) 295-4028. Email: maria.lopes-tyburczy@hackensackmeridian.org.
  • Kim Rice, MHA, Director of Patient Access, Shasta Regional Medical Center, Redding, CA. Phone: (530) 229-2944. Email: krice@primehealthcare.com.