If patient access staff at Arlington-based Texas Health Resources want some reassurance that they really can move up in their jobs, they can just look around. Every single manager and director currently working in the department was promoted from within.

“Employees know that it can happen for them, too, with hard work,” says Alyssa McDonnold, CHAM, director of the patient access intake center.

Certain patient access staff are the ones that colleagues always turn to for help. “They are the ‘go-tos,’ the people everyone relies on. They are leaders, but without the title,” McDonnold reports.

The department made a concerted effort to do something for these unsung heroes. “You can take an employee with a natural leadership gift, and mold and mentor them into the leader your department needs,” McDonnold explains.

Staff promoted from within are strongly committed to their new role. “In the end, you have less leadership turnover,” says McDonnold, adding that her department recognizes the “go-to” employees two ways:

The most promising patient access employees can attend a leadership training class. This idea stemmed from McDonnold’s own experience with a year-long program at Texas Health University. The program is designed for high-producing managers with the goal of becoming a director. McDonnold learned so much from the program that she created something similar for patient access staff: an eight-month program that teaches leadership and teamwork.

All patient access employees received an email that included information about the class and an invitation to apply. Ultimately, six employees were chosen, three each from preaccess and insurance verification. McDonnold taught the first class, then the department’s applications trainer took over.

At the end of the program, each participant chooses a topic to present to leaders. “Some focus on relevant problems that they hear about from their peers that leaders may not even be aware of,” McDonnold says.

One employee created a presentation called “Dr. SnapChat” about virtual physicians available to patients online. Another presented information on patient satisfaction from the frontline point of view. Karlei Carrico was one of the first group of patient access employees chosen for the program.

“After the program, I applied the skills to my position. This professional growth led me to be promoted into a new position,” says Carrico, now a revenue cycle electronic health records trainer.

A career ladder separated patient access roles into level 1 and level 2 positions. The level 2 role already existed informally. “They are the go-getters of the department,” McDonnold notes.

The problem was that these standout employees were not recognized in any formal way. The first step was to create a separate job description that spelled out how level 2 employees differ. Mainly, they are held accountable to higher standards for Key Performance Indicators. Also, level 2 staffers are assigned to work with between five and seven new employees. “We call them ‘Promise Pals.’ They work alongside the new hire for the first month, and act as their contact person thereafter,” McDonnold says.

Most new hires are confused about which CPT code to use or how to give an accurate price estimate. That is where the Promise Pals step in. “The new hire can go to the Pal and get the information,” McDonnold says.

Trish Vartan, a recently promoted level 2 rep, says that serving as a Promise Pal “has really taught me that I am a leader within my department and to my peers.”

With level 2 employees fielding most questions from new hires, senior leaders can work on other departmental priorities. “The amount of questions we were getting were endless, all the time,” McDonnold reports.

Before Promise Pals existed, employees at more than a dozen hospitals in the health system called continually with questions about authorizations, estimates, and more. It was not that the employees were terrible at their jobs; rather, things in the department are changing constantly. “Even though they know their jobs, new scenarios come up every day,” McDonnold explains.

The job description made it clear that level 2 reps work harder and handle more tasks than their level 1 peers. This resulted in HR approving a pay grade increase.

Several years ago, the department had created a similar role without extra pay. Staff expressed little interest in taking on the duties. “There’s a fine line between what you can ask somebody to do without a pay increase,” McDonnold offers.

Still, it took more than just a new job description to convince HR that level 2 people should be paid more. Leaders also researched compensation of similar roles at other hospitals. “We were able to show that the industry standard is going in this direction,” McDonnold says. It also helped that the hospital’s Central Business Office had created a similar role — at a higher pay grade. “We reached out to HR, and said, ‘We see the need for this in our department, too,” McDonnold recalls.

After defining criteria the level 2 employees have to meet, HR came back with the pay rate difference. “Turnover is very solid in the level 2 position,” McDonnold adds. “When people do leave, it’s normally an internal transfer within the company.”