Access descriptions are likely outdated

Update with new skills

Until recently, members of the patient access staff at St. Joseph's Hospital Health Center in Syracuse, NY, were assigned a generic "customer service representative" title that didn't reflect what they actually did.

"The title was used for multiple departments who had a variety of job functions, many that were not related to patient access functions," says Carol Triggs, MS, director of patient access.

In 2001, a separate job description was created for patient access representatives to accurately reflect the skill sets, training, functions, and responsibilities required of patient access staff. For example, members of the access staff are required to be proficient in multiple software systems.

In addition, every area of patient access has a specific job description tailored to the actual daily functions specific to their area, explains Triggs. For example, centralized scheduling or pre-registration job criteria are different than the job criteria of an ED patient representative. "We wanted to ensure that their job functions were accurately compared during the compensation surveys performed by human resources," Triggs says.

Obstacles with evaluations

If patient access job descriptions are outdated, these no longer will cover job expectations when you complete performance reviews, warns Wendy M. Roach, RDMS, manager of patient access and central scheduling at Advocate Good Shepherd Hospital in Barrington, IL.

For example, an associate might be required to attend 75% of staff meetings annually. If that expectation is not listed on the job description and is not included in signed department guidelines, it can be difficult to hold associates accountable for meeting the criteria, says Roach. "If you are adding 'Did not meet the requirement to attend 75% of staff meetings' to the performance review, it becomes the 'It's not in my job description' scenario," says Roach.

More pay for access

"The requirements included in a job description will determine the pay scale for the position," says Roach. "Adding or taking away one thing can really make a difference." For example, the pay scale goes up if a staff member obtains certification as a certified healthcare access associate.

"When you add in different requirements, you can then develop tiered job descriptions," says Roach. "This is something that we are in the process of developing."

A Tier 1 description is for a basic registrar with no certification and works only in one area, while a Tier 2 description is for a registrar that has certification, can precept, and can work in more than one area, she explains.

"As the requirements increase, the pay increases," says Roach. "If descriptions are not current, there is a potential concern of not being competitive with your market." (See related stories on utilizing job descriptions when hiring, and how job descriptions can affect the ability to evaluate staff, below.)


For more information on updating patient access job descriptions, contact:

  • Carol Triggs, MS, Director of Patient Access, St. Joseph's Hospital Health Center, Syracuse, NY. Phone: (315) 448-5379. E-mail:
  • Wendy M. Roach, RDMS, Manager, Patient Access and Central Scheduling, Advocate Good Shepherd Hospital, Barrington, IL. Phone: (847) 842-4186. Fax: (847) 842-5325. E-mail:
  • Ramon Velez, Director of Patient Access, Emory Hospitals, Atlanta. Phone: (404) 686-7070. Fax: (404) 686-0203. E-mail:

Obtain higher level of access applicants

Updated job descriptions in your patient access department will attract a higher level of applicants who are more likely to meet your expectations, according to Carol Triggs, MS, director of patient access at St. Joseph's Hospital Health Center in Syracuse, NY.

"We have increased recruiting efforts this past year for our newly expanded ED," she reports. "Having a new job description which clearly outlined the requirements, functions, responsibilities, and necessary training was very helpful."

Triggs adds that she would not have been able to set realistic performance expectations for an applicant otherwise, and applicants wouldn't have a clear understanding of the position.

Up-to-date job descriptions can help you hire quality associates who are meeting industry norms, says Wendy M. Roach, RDMS, manager of patient access and central scheduling at Advocate Good Shepherd Hospital in Barrington, IL. "This allows us to continue to be financially competitive with our market," Roach says. "We can identify required expectations that we can then hold staff accountable for."

Inaccurate description of access is costly

Evaluations, hiring are problematic

Several years ago, it was becoming painfully obvious that registrars at Emory Hospitals in Atlanta deserved a pay increase due to their expanded responsibilities, reports Ramon Velez, director of patient access. However, their job description posed an obstacle.

"It was unfair, because the front end was doing a lot of work that used to be done on the back end," he says.

The problem was that access representatives' job description was outdated, reflecting an entry-level position that primarily was responsible for data entry at the time it was written, says Velez. "It was obvious we had to pay them more money," he says. "If not, that same person would prefer working in the business office where they would be paid more."

To avoid losing staff to other areas of the hospital, a decision was made to give the patient access employees the same job description as the business office staff, so they would be paid on the same scale, says Velez.

"We transitioned our access folks to a patient accounting job description, in order to get them more money," he explains.

Evaluation is difficult

However, the continuing expansion of the access role at Emory Hospitals has led to some problems evaluating employees.

"The problem we are confronting now is that what access and the business office do is totally different," says Velez.

Managers are finding it tough to evaluate staff on key functions of their job, such as customer service, since these aren't included in the job description. "That means that evaluations tend to be a little more subjective. It is more difficult to say to an employee, 'You aren't meeting that standard,'" says Velez.

Providing excellent customer service has become a top priority for access staff, for example, but this isn't part of the job description of business office staff. Velez also needs applicants who can handle financial counseling and insurance verification.

"I tend to look for an employee with a mixture of healthcare experience and some type of customer service or retail experience," he says. "None of that is in the current job description."

It also makes it difficult to find qualified applications for access positions, which costs the hospital more in the long run, says Velez. "Cleaner information is required on the front end," he explains. "If you hire somebody with less know-how, you will have to QA their work extensively to make sure you are billing appropriately."

Velez is working with human resources staff on updating the job description of access staff to reflect these realities.

"In the old days, you didn't need healthcare experience, because all you were doing was key punching," he says. "Now we need someone who can handle collections while maintaining a high level of customer service."

The department is switching to centralized scheduling, which will call for cross-training and additional skill sets, says Velez. "It will be a one-stop shop," he says. "We will schedule the patient, take their demographic information, and verify insurance, all at one time."

This change means the access representative job description will need updating again, says Velez.

"We've all been under pressure to maintain or reduce FTEs as the reimbursement model continues to change," he says. "When people call out or take vacations, we'll be able to pull staff from another area. Instead of having 200 employee in silos, we can use them across the whole system."