Seamless’ new call center improves facility’s customer service and billing

One call can answer patients’ hospital and physician billing questions

Providence Health System in Portland, OR, has improved customer service and gained staff efficiency by creating a call center that allows patients to handle physician and hospital billing questions with one telephone call.

"We were trying to find a way to be seamless to patients," says Jessie Hofstetler, manager for the inbound call center. Another manager oversees the outbound call center, she adds, but employees now are trained to handle both kinds of calls and are located in the same space.

"When patients called about a bill from a clinic that was Providence-based, we wanted to also be able to address their hospital bills, rather than have them make two separate calls to different places," Hofstetler says. "[Before], they’d say, Aren’t you Providence?’ They couldn’t distinguish the difference. They’d go to the physician for an exam, but the labs were sent to the hospital."

The newly cross-trained employees handle the inbound and outbound calls regarding hospital accounts, in addition to the inbound calls concerning physician office accounts, Hofstetler explains.

Staff handling outbound calls for physician accounts still report to the physicians’ billing office (PBO), but work in the same space, notes Kristi Gwilliam, who, as supervisor for the inbound and outbound call center, reports to both call center managers. Because of their physical proximity, she adds, these employees can now communicate more easily with their hospital counterparts.

Before the consolidation, Hofstetler says, PBO customer services representatives and regional business office (RBO) representatives were in the same building, but on two different floors at opposite ends. The first move, in the fall of 2001, brought together the PBO and RBO staffs handling inbound calls, she adds. In December 2002, the outbound representatives were added.

When the two groups were combined, "everyone had to be able to understand and learn the other’s system," she adds. "There are differences in how the clinics bill and collect accounts, and how the hospital does. We were in a growing phase for a while."

"The greatest challenge we had is that [the PBO] system seemed more cumbersome," Hofstetler notes. "If you have to make changes, like an address update, you have to do it in every account. It just takes longer. You just work at finding the positives in it and at encouraging staff to keep learning, to think of ways to streamline the process."

One example of the streamlining that has occurred, she says, has to do with the "standard note" function on a computerized account. Previously, each time a patient called and asked to add an insurance company to the account, Hofstetler explains, the person taking the call would put a note in the computer to that effect, print the screen, and put the printout in the mailbox of someone on the team who handles insurance matters.

"This past year, we created a standard note, so that the employee [taking that information] would punch in a number that meant add commercial insurance,’" she says. "That would come out on the note [in the system]."

"Maybe 30 or so of those [notes] are put on a report that is distributed each morning to the people on the [insurance] team and they work from that report," Hofstetler adds. "It saves time and money."

Other numbers, Gwilliam points out, are punched in to indicate Medicare or Medicaid coverage. "It keeps staff from having to distribute these reports, and from having to figure out who they actually go to. There’s no more paper passing."

Keeping track

As employees have become more proficient in being able to move around both computer systems, Hofstetler says, efficiency has increased. When the new center was created, there were about 25 full-time equivalents, she adds, "but we’re now down to 20."

Because the call center is open from 8 a.m. to 8:30 p.m. on weekdays and from 9 a.m. to 1 p.m. on Saturdays, she adds, there are both full-time and part-time employees.

To encourage gains in efficiency, Hofstetler says, the call center tracks the total number of calls received each month — around 35,000 — as well as the number of "two-in-one" calls, where more than one issue is resolved.

In the latter cases, she explains, staff may take a proactive approach. "We get about 500 calls a week where the person wants to know what the bill is with the hospital, and [the customer service representative] checks the physician accounts and sees an outstanding bill there as well."

Using a telephone tracking system, the center monitors how long an employee stays on a call and how long he or she spends in after-call work, such as making a notation on the account or looking up the explanation of benefits to see if a payment was posted correctly, Hofstetler says. "We look at whether the rep is doing that within three to five minutes."

Each customer service representative is expected to handle between 80 and 110 calls per day, she adds. "We measure all the calls they transfer and say they can’t resolve, Hofstetler notes, and those can’t exceed a certain percentage. We track all abandoned calls [when the caller hangs up before reaching a representative], which also have to be kept to a certain percentage."

If the percentages aren’t acceptable, she says, "we pull other staff to fill in. There is a certain standard we have to meet."

There are five employees from throughout the office — from the RBO and PBO staffs — who are trained on both computer systems and able to fill in when needed, Hofstetler says. "Their [normal] roles are, for example, a collector for the physicians, or a member of the credit team, but if there are 20 calls in the queue, and the call center staff can’t keep up with the volume, these are people we can call."

"We’ve really worked hard," she adds, "at having the offices buy into the belief that the first priority is the customer."

Space promotes communication

While the customer service representatives were used to working in cubicles with high sides, Hofstetler notes, those walls have been lowered in the new space to facilitate communication. "[Employees] can see what everyone else is doing, and they can see [managers and support personnel]."

"We created an elevated area within the new call center, called the support area, for the support team," she adds. "When the staff are handling a tough call and need more help, all they have to do is press a button and a member of the support team is available and will help them get through it."

That support person — who, if necessary, may be the team trainer or a supervisor or manager — will either walk over to the employee’s desk or access the same account and communicate by telephone, Hofstetler explains. "Somebody is always available to help staff. That’s really our goal — to support the team."

One of the big pluses of the call center, she points out, is that there are customer service reps who are bilingual in a variety of languages.

Callers who are having a difficult time resolving their concerns with the first responder because of language difficulties are asked if they would like to have someone help them in their native language, Hofstetler adds.

Spanish, Vietnamese, and Chinese speakers are available, she notes. "We want to find a Russian [speaker], but it’s hard." If the appropriate rep is on another call when a person needs the language help, the information can be left on a voice message box, Hofstetler says. "We check it whenever the light is on."

"If a person calls in and can’t understand and only speaks Chinese, the rep will say something very simple, like, I will transfer you to a message, you talk,’" she adds. "We will return the call within 24 hours."

Future plans for the center include using an automated coaching tool that will help reps find ways to increase efficiency, determine which screens to select, and say things more effectively, Hofstetler notes.

From the beginning, she points out, her job has been made easier by a "great team who was willing to experiment. They had a lot of fun with the challenges, and would push each other to meet a goal. We would celebrate at the end."

[Editor’s note: Jessie Hofstetler can be reached at (503) 215-4301 or by e-mail at]