Updated job descriptions needed for patient access!
Proceed with caution when updating access job descriptions
Be prepared for staff members’ responses
That’s not in the job description I was given." When a patient access employee made this statement during an annual review, it was difficult to respond because it was true, says Steven K. Cochran, CHAM, patient access supervisor over admissions and emergency room (ER) registration at Och Regional Medical Center in Starkville, MS.
Cochran realized that the job descriptions he was using to evaluate employees didn’t reflect what they actually did on a daily basis. As a result, he is updating these.
Cochran says the new job descriptions will be a much better tool during the hiring process because they will allow him to make a good decision on which candidate is the best fit for the available position. "It sets the tone from the very beginning of what your expectations are in your employee/supervisor relationship," he adds.
Reviewing updated job descriptions with existing employees is an opportunity to emphasize to staff members, who sometimes feel underappreciated, how vital their role is to the hospital, says Cochran.
"When dealing with long-time employees, it gives you goals to set and achieve," he says. "It prevents them from feeling they are in a position that is becoming stagnant and routine."
Take these steps
Patient access leaders at Riverside Regional Medical Center in Newport News, VA, recently updated all of the job descriptions for their department.
"The registrar’s role has expanded greatly over the past few years," explains Robin Woodward, CHAM, director of patient access. "That needed to be acknowledged and reflected in the job description." Woodward took these steps:
• She obtained input from the administrative director, who sent the revised job descriptions to compensation for re-pricing consideration. Pay increases were approved, based on the new job descriptions.
• She notified team members that their job descriptions were being revised.
"Team members may have input on an item that we in management may have overlooked while making revisions," says Woodward. For example, staff reminded Woodward that they needed time to escort patients to their next location, which is a big patient satisfier. Two minutes were added to the wait time expectation listed in the job description, which is currently 15.5 minutes or less.
• Lastly, Woodward reviewed the new job descriptions with each employee.
Ask staff what they do
As part of the process of updating job descriptions, Cochran is talking with employees about what they do in their jobs.
"I am making a point of involving the staff in researching this information," says Cochran. "I am finding that they are mentioning responsibilities and duties that I had actually let slip my mind."
Once Cochran has received all the input from his employees, he will compare their lists with the responsibilities that he thinks should be added. "Then I will make the edits and additions to our existing job descriptions," he says.
The biggest new responsibility in the job descriptions is going to be upfront collections, says Cochran, adding that this will help him find people able to confidently collect from patients in a courteous manner.
"This is something that people tend to be too soft’ on in our rural area," he explains. "This is a primary focus in my interviews."
Have responses ready
When Cochran announced his intention to update patient access job descriptions, employees mostly were pleased that their expanded role was being acknowledged. However, he also encountered these two responses:
• "This is the way we’ve always done it."
Some employees resented the updated descriptions because they thought they were being asked to do additional work. Cochran responded by saying, "You expect your salary to increase and change with each passing year. So your responsibilities should, too."
"I also reminded them of the importance of everything that we do," he says. "They impact the entire revenue cycle and operations of the facility. They are much more than just data entry clerks."
• "Since you are adding more duties and responsibilities, shouldn’t I get more pay?"
When staff members asked Cochran this tough question, he reminded them that pay raises are earned, not something they are automatically entitled to.
"Actively including your staff in decisions and changes regarding policies and procedures helps to eliminate, or at least lessen, this type of attitude," says Cochran.
For more information on steps to take when updating job descriptions, contact:
• Thomas P. Buckley, Vice-President Revenue Cycle, Patient Business Services, Virtua, Marlton, NJ. Phone: (856) 355-2020 Ext. 52020. Fax: (856) 355-2171. Email: email@example.com.
• Steven K. Cochran, CHAM, Patient Access Supervisor, Och Regional Medical Center, Starkville, MS. Phone: (662) 615-2581. Fax: (662) 615-2619. Email: firstname.lastname@example.org.
• Robin Woodward, CHAM, Director, Patient Access, Riverside Regional Medical Center, Newport News, VA. Phone: (757) 594-4211. Fax: (757) 594-4495. Email: Robin.Woodward@rivhs.com.
Put excellent service into job description
Virtua, Marlton, NJ, recently made changes to its patient access positions, with an emphasis on providing excellent customer service, reports Thomas P. Buckley, vice president of the revenue cycle and patient business services.
Previously, patient access job descriptions primarily were focused on the amount of time it took to complete various functions. For example, it took about 60% of a registrar’s time to enter a patient’s demographic, financial, and insurance information into their system, and another 20% of time to obtain signatures on all required documents.
The updated job descriptions take into account the expectation that patient access staff create an outstanding patient experience, says Buckley. "The Virtua patient access staff is helping our community be well, get well, and stay well, one person at a time, by alleviating suffering and delivering acts of kindness," he says.
"Seemingly small" behaviors
Patient access relationship-based care can be achieved in ways that don’t involve a large percentage of time, Buckley explains. For example, acknowledging a patient’s arrival with "Good Morning, Mr. Smith," or asking friendly questions such as "How was your drive in today?" don’t take much time, but are very important to the patient access role.
Other patient-friendly behaviors that take little time are making eye contact or knocking on patient’s door before entering. "Although these seemingly small behaviors have a huge impact, they generally are not identified on patient access job descriptions," says Buckley. He made sure these behaviors were included in the department’s updated job descriptions by specifying expectations for "communication," "courtesy," "respect," and "professionalism."
This information is helpful during the hiring process, he says, because managers can ask candidates to respond to requests such as, "Give me an example of how you used courtesy during a registration."
"Examples can range from holding a door for a patient, to listening as patients tell their story, to calling physician practices to help the patient navigate the healthcare continuum," says Buckley.
Staff keenly aware of their bigger role
They’re ready for a challenge
Patient access employees at Riverside Regional Medical Center in Newport News, VA, were happy about their job descriptions being updated, because they already were very aware their role has broadened, says Robin Woodward, CHAM, director of patient access.
"There are a lot of things registrars must remember to do," says Woodward. "Patient access team members do want to be challenged and move beyond a registration desk."
Below is the updated job summary for a registration representative:
• Effectively utilizes all department-specific computer and telephone systems.
• Responsible for registration of all patient types and statuses, having full understanding of the requirements for the charity program and self-pay processes, network/out of network, authorizations versus no authorizations, medical necessity, providing quotes, calculating patient payments, electronically posting patient payments, identifying issues, and reporting trends.
• Acts as a liaison between the patient access office and all other departments and insurance companies, providing consistent and relevant detail on issues and trends.
• Demonstrates strong problem-solving skills, high attention to detail, and an aptitude for learning.
• Promotes teamwork and customer service by demonstrating positive interpersonal relations.
Riverside Regional’s patient access team members are encouraged to complete cross training in other departments. They move up the department’s career path, as follows:
• Registration representatives must be cross-trained to cover one area within the department, such as surgery check-in, emergency department registration, or the information desk.
• A registration associate must be cross-trained to cover all areas of their assigned department, which could include obstetrics, emergency department, admitting, and cashier.
• A revenue cycle associate must be able to cover another area outside their department, such as the call center, patient accounting, or scheduling.
"You must be in each role a year to advance. Each advancement level is a new grade in pay," says Woodward. Three to five employees participate each year, and employees are encouraged to do so at their annual evaluations. Here are the requirements:
• Individuals must be in each level at least one year/
• Each level requires the individual to complete required responsibilities, classes, and competencies.
• The employee must meet a certain score on the annual evaluation and maintain a required accuracy rate.
"The goal of our career path is to recognize and advance revenue cycle team members who demonstrate excellent customer service, positive interpersonal communication skills, and relationships with patients, families, and interdisciplinary healthcare teams," says Woodward.