About 25 of 150 registration associates at Albany (NY) Medical Center are cross-trained to work in multiple registration areas, including the ED. This helps the ED cope with sudden volume surges, but some employees ask to be cross-trained just because they want overtime.

“While this provides a wide pool of assistance, it also requires careful screening,” says Karen Gardner, CHAM, manager of patient access services for the ED. To be cross-trained for the ED, Albany Medical Center’s registrars must be:

  • a medium to high-performer in registration accuracy, with 95% accuracy in data entry, insurance eligibility, selection of payer/plan, and consent completion. “We do not want someone who is not meeting goals in one department training in another,” Gardner notes.
  • able to work independently. “If there are any concerns from their primary manager, a staff member is not considered for assisting other units,” Gardner reports.

Registrars cross-training in the ED work the fast track first, where lower-acuity patients are seen. This acclimates them to the flow of bedside registration, a task which many have never experienced.

“As their comfort level increases, we move them into the higher-traffic areas,” Gardner says.

After a few shifts in the ED, some registrars decide they just can’t work there regardless of the area or assignment. “This is never held against a staff member,” Gardner notes. These registrars leave the ED with a greater understanding of its complexity. They realize why a registration may be missing a data element or a general consent for a patient with a severe medical condition.

“They take this understanding back to their home units,” Gardner says. “There is less ‘if the ED just did their jobs.’”

Some cross-trained registrars do not want to work in the trauma/critical care area, but do enjoy working in the fast track.

“This still benefits my department. I fully support and respect anyone who knows their limitations,” Gardner says.

Gardner says employees are probably a good fit for the ED if they:

  • react quickly to interview questions;
  • can advocate for themselves without acting pushy;
  • remain interested after a tour of the ED.

“If outside applicants request ED registration positions, managers have them work alongside staff for a full hour during a high-volume time,” Gardner adds.

Behavioral-based questions give valuable insight for how someone will react to the ED. Gardner’s favorite questions to ask include the following:

  • “When you feel yourself becoming stressed but cannot leave a situation, what tactics do you use to de-escalate yourself?”

Some applicants claim they never get stressed.

“This applicant is either not in touch or lying to themselves,” Gardner says. Another red flag: “Passing the buck” statements such as, “I call over my supervisor and let them deal with it.”

“This is the same as saying ‘it’s not my job.’ This is never an acceptable response, so I generally finish up the interview quickly at that point,” Gardner says.

There is no particular “right” answer to the question about stress levels.

“What works for one person may sound crazy to the next person,” Gardner explains. “It’s more the feeling I get that this person knows their stressors and has a process.”

  • “When was the last time you broke the rules and why?”

Some applicants claim they never break the rules.

“I immediately do not believe them,” Gardner says. “I also find admissions of breaking a company policy to be off-putting.”

Some applicants find the humor in the question, showing they don’t take themselves too seriously. One candidate shared that he got caught driving on a suspended license, and added, “I was actually on the way to motor vehicles when I got stopped. I knew I should have taken the bus.”

“This showed me accountability and acceptance,” Gardner says.

  • “Can you describe a group project you were involved in?”

Typically, applicants describe something they worked on at school. What’s important is the ability to work well with others.

“If someone’s response disrespects their teammates or teachers, I generally find they will not work well in a group,” Gardner says. If the applicant can’t think of a group project, they’re asked to come up with a solo project. One applicant talked about planning her wedding all by herself because she wanted it right.

“That didn’t inspire me to believe the applicant was going to work well in groups,” Gardner notes.

  • “Tell me something that you learned or changed based on a failed attempt.”

One applicant spoke about a failed job interview. When she wasn’t offered the position, she requested a follow-up appointment to discuss how she could have presented as a better candidate.

“I appreciated that, and have passed that advice on to my children,” Gardner says.


  • Karen Gardner, CHAM, Manager, Patient Access Services, Emergency Department, Albany (NY) Medical Center. Phone: (518) 262-8544. Email: GardneK@mail.amc.edu.