2004 Salary Survey Results

Outsourcing, consulting opportunities on tap for well-prepared AM professionals

Technology, revenue cycle skills most valuable

Increases in outsourcing, the merging of health care organizations, and changes in the consulting business may equal some new opportunities for qualified access management professionals. Skills that will be most in demand, several health care job placement specialists indicate, include a firm grasp of technology and a sophisticated understanding of the entire revenue cycle. There continues to be a large demand as well for people with medical records experience, and for a broadening of financial skills across the board. (To see tables illustrating the results of this year's salary survey, click here.)

Continuing education, meanwhile, is more crucial than ever, suggests Colleen Campbell, a recruiter for an executive-retained search firm based in Mission Viejo, CA, that specializes in the health care industry. "Wherever we’re doing the recruiting, the emphasis is on good education."

"As candidates continue to move up and look for other opportunities, we’ve noticed that the pedigree or education is something that senior teams are focused on more than in the past," Campbell says. "The requirements have gone up because those who are concerned with finance have to be at the top of their game."

The candidate pool is getting stronger, she says, as the next generation of candidates tends to get advanced degrees or certifications earlier in their careers.  The ideal candidate will have career stability as well as a good education track, Campbell adds, staying long enough at a position to have demonstrable achievements.

Noting that salaries tend to be higher in California, she says a director of patient financial services at "a decent-sized hospital" might expect to make somewhere between $100,000 and $120,000, with the figure climbing closer to $130,000 if the person has regional oversight. Increasingly, Campbell notes, individuals at the director level will need a broad knowledge of financial systems. "They [must] have that because they are hands-on and accountable. I don’t think a person can be in that role today without a good grasp of technology. It’s just the wave of the future."

The managed care industry is contributing to the demand for more well-rounded candidates, says Chris Cornwall, president and CEO of Searchlight Recruiters Inc. in Laguna Hills, CA. "As managed care increases in the United States and we see a compression in reimbursement," Cornwall says, "a lot more hospitals have merged and aligned forces with organizations that might have been direct competitors in the past."

With this trend, "new jobs are being created, but other jobs are going by the wayside," he adds. "Because of the consolidation of the business force, more hospitals are looking for more sophisticated, experienced [employees]."

To fill this need, Cornwall says, hospitals are drawing on "a lot of people who have come up from different parts of the revenue management cycle — people who have come up from patient access, as well as from patient accounting, to higher and higher levels."

"Hospitals are using technology more and more to get a better grip on costs and to increase collections, among other things," he says. "I see technology playing a greater role, particularly software applications that are able to capture more of the earned revenue within a hospital. So we’re seeing a need for people who understand and have been trained on these systems."

Another trend he has noticed, Cornwall points out, is an increase in outsourcing. Some of the large outsourcing firms are able to provide greater expertise than is available at small hospitals, he notes, and even larger hospitals may find outsourcing beneficial because the outside firms are more efficient at certain functions.

The changes taking place in the consulting business may provide opportunities for access management professionals with solid revenue cycle experience, suggests David Borel, managing partner for health care at the Atlanta-based firm of PeopleSearch Solutions. Smaller, spin-off companies created from the leadership of the "Big Four" service firms "are beefing up right now," he reports. "They’re using their past relationships to bid on deals and are offering better pricing points than the Big Four."

As a result, these firms are "frantically looking for qualified resources, for any kind of revenue cycle management [expertise]," Borel adds. "For someone coming from a hospital environment wanting to get into consulting, there are a lot of opportunities there."

Candidates for those opportunities will be made more attractive by experience in medical records, patient accounting, and patient financial services, Borel says, as well as by "an understanding of the whole ancillary [operation] — even from the clinical side." He agrees that individuals "with hands-on exposure to technology will present themselves a lot better in the marketplace. It’s more and more a part of anything you do."

In some cases, a consulting organization will be hired by a hospital and will need to put in, for example, an interim patient financial services director, Borel notes. "I will find someone to do it on a contractual basis for six to nine months." Such internal consultant positions can be "quite lucrative" at present, he points out. "It can be feast or famine. Right now it’s feast. It wouldn’t be as big of a trend if business wasn’t good."

A client he recently placed had worked as a senior manager for a consulting firm, was a financial director for a health care organization before that, and had spent seven years as a revenue cycle consultant, Borel says. That individual, who has an MBA in finance, is now interim patient financial specialist at a hospital, being paid about $800 a day, which, annualized, is $208,000, he adds. The same person placed in another consulting organization could expect to be paid between $140,000 and $150,000; and if hired for a full-time position at a hospital, would make between $105,000 and $120,000, Borel says. "It depends on the region of the country," he notes, "but there are two premiums — one for the travel, and one because you’re an independent and don’t have benefits."

Borel says he also has noticed a trend away from people placing salary at the top when they weigh job opportunities. "Compensation overall has come down from where it was three to five years ago, when it was on the forefront of people making changes," he adds. "Now it’s in the top three or four [priorities], but it’s not one or two."

What’s more important for today’s job seekers, Borel says, are such considerations as "who you’re working for, whether there’s travel, or where the position will take you with a particular company. Just to get $5,000 more isn’t a reason to select one job over another."

Those who are looking to make a career move can take encouragement from what appears to be a "good, forward movement" in health care employment, notes Campbell. "The last year to year-and-a-half, compared to about a year before that, the job market has picked up. [Organizations] are hiring again at the senior to executive level."

Given the aging population, adds Cornwall, there will be continuing demand for jobs that can help control health care costs. "The jobs where employees can add marginal value toward helping conserve the health care dollar — those are the jobs that will be growing in the future."

Salary breakdown

The greatest percentage of access professionals responding to Hospital Access Management’s 2004 salary survey — 21.43% — reported making between $50,000 and $60,000 a year. The next largest category — 15.48% — included those with salaries of between $40,000 and $50,000, while 13.10% said their annual income is between $60,000 and $70,000.

Just more than 9.5% reported paychecks of between $70,000 and $80,000, and the same number said their salary was between $80,000 and $90,000. At the higher end of the pay scale, 8.33% reported incomes of between $90,000 and $100,000, and the same number said they make between $100,000 and $130,000.

Of four choices for job title listed in the survey, the most commonly selected was "director, access management" (32%), but almost 30% checked "other" in that category and a number of those wrote in such titles as "corporate director," "regional director" or "regional manager" of access management. Another 30% selected "access manager" from the choices given.

The vast majority (87%) worked for nonprofit hospitals, while the remainder said the ownership or control of their employer was best described as state, county, or city government, or a college or university. A third of this year’s respondents were affiliated with hospitals in the Midwest, while the next largest number (28.57%) worked in the South; 19.05% in the Northeast; 14.29% on the West Coast; and only 4.76% in the West.

When it came to the type of location, however, their facilities were divided almost evenly between urban, suburban, medium-sized city, and rural settings. The overwhelming majority of respondents – just under 80% — got a pay raise in the past year, with most of those increases falling in either the 1% to 3% range (36.90%) or the 4% to 6% range (30.95%). Just fewer than 12% received an increase in salary of between 7% and 10%.

The gender gap in access management, meanwhile, was a bit less dramatic in this year’s report: About 76% of respondents were female, compared to 85% in 2003.