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Proactive approach leads to revenue job
I tried to be the best’
Throughout a couple of different access careers — interrupted by a brief stint as an elementary school guidance counselor — the thing that stood out for Millie Brown was how much more impact she could have on the front end of the health care financial process than on the back end.
Recently named senior director of the revenue cycle at Children’s Healthcare of Atlanta, Brown also has some advice for those who feel stuck in a dead-end job but don’t want to take a step backward in order to take another one forward: "Sometimes, that’s the right thing to do." And she adds, "Whatever I was doing, I tried to be the best at it, to be excellent, even if it was something I didn’t love."
Those times of not loving the job appear to be even farther in the past as Brown moves from a successful tenure as director of patient access to her new position, where her role will be examining the various parts of the revenue cycle and coming up with appropriate quality processes. First on the list, she says, will be outpatient clinics, the organization’s cancer center, rehabilitation services, and other areas where access functions were not directly under her supervision as patient access director.
"I will go into the area and perform a SWOT’ [strengths, weaknesses, opportunities, threats] analysis, look at strengths and weaknesses, what the opportunities are, what the threats are, and then help put [improvements] in place," Brown says.
Before, she explains, the managers in those areas were invited to attend meetings aimed at enhancing their effectiveness, "but sometimes they would come, and other times they didn’t." While the main access area was running efficiently, Brown adds, there were pockets of these outlying access operations that weren’t doing well at all.
"I’m going in to make sure everybody is equal in terms of expertise," she says, noting that she will be "almost like an internal consultant, except that I will be helping with implementation. Hopefully, I will take what I’ve done [as patient access director] and mirror it in different places."
Moving up the access ladder
Before coming to work for Children’s about five years ago, Brown notes, she had worked as a financial counselor and later managed a billing office at another health care organization. She left that job to become an elementary school guidance counselor, she says, because she was attracted to the shorter commute and earlier quitting time. After meeting someone who worked at Children’s, she was drawn back into the access field, Brown says, when she was offered a financial counseling job that allowed her to keep the same work hours she had at the elementary school.
"One day the billing director brought me some bills and said, All these bills were denied,’" Brown adds. "She asked me to check to see if I had entered something wrong."
Knowing she wasn’t at fault, Brown nevertheless corrected the bills, took them back to the director, and explained that the errors had to do with how the claims were processed. "I said, I’d be happy to show [the billers] what went wrong and how I would have handled the claims."
That conversation eventually led to Brown being offered the job of billing manager, which she accepted — despite the return to longer hours. As financial counselor, she adds, "I found it frustrating not to be able to effect change."
After a little more than a year as Medicaid billing manager — during which Brown implemented a new system that led to a substantial decrease in accounts receivable (AR) days — she was asked to become access director. "They originally offered me the director of patient accounts position, but then changed [the offer] to director of access," notes Brown, who says she was pleased with the change in plan. "I felt [access director] was a job in which I could have the greatest effect on the system. We had good managers in billing and so I knew that being able to marry the two [areas] would make us successful."
A proactive approach
As the newly hired access director, Brown focused immediately on the quality of registration data — specifically the proper identification of patients’ insurance plans — which resulted in more than 75% of claims being paid the first time out. The positive financial impact on the health system was approximately $20 million less in annual denials.
A proactive approach has always been her hallmark, she explains. Working as a financial counselor at her previous organization, Brown notes, she could only get credit for her successes in finding coverage for patients if they resulted in the account actually being paid. Those accounts, however, often were written off for lack of timeliness or other billing mistakes. "I finally said, Why don’t you let me bill my own accounts?’ So they did — it was more or less on a dare." The challenge paid off for that facility, which resulted in a drop in AR days from 140 to 56 over a three-month period, she adds.
Looking back over her career, to date, Brown notes that she left management positions twice, started over as a financial counselor, and then worked her way up to get even higher on the access ladder. Hence, her advice about not being afraid to take a step backward if it seems appropriate.
Brown has a few other pieces of advice that she shares with her team: "No 1: Always look and act like the leader you want to be. No. 2: Find a mentor — preferably more than one, because not everybody does everything well — that is the best at what you want to improve."
And, she adds, perhaps most importantly, "Be the one that is always there to help others — whether they’re your staff or your peers — because when push comes to shove, they’ll be there for you."