Access career ladder promotes staff retention

Three registrar levels available

The access career ladder at Carolinas HealthCare System (CHS) in Charlotte, NC, grew out of two realizations, says Katie Davis, CAM, assistant vice president for patient registration:

1. Access employees who don’t have the desire or aptitude to be a supervisor or manager need a way to experience career growth.

2. The opportunity for such advancement is a good way to promote employee retention.

"Not everybody wants to be or should be a supervisor or manager, and there are not that many positions that come open," Davis points out. "We did, for a while, experience a fair amount of turnover, and in looking at what makes it more attractive to stay in registration, [a career ladder] was one of the first things we decided to do," she explains. The program is open to all full-time staff in corporate registration, which leaves out registration employees who work in the system’s clinics, Davis explains. "They come under the Carolinas Physicians Network [CHS]." Once new hires in corporate registration have completed a 90-day probationary period, they are eligible to participate, she notes.

Level One Registrar

"Everyone comes in as a Level One Registrar," Davis says. "They are expected to demonstrate basic knowledge and skills and behavior consistent with the advanced competent beginner stage. There are important situational elements you can only learn through experience."

Level One employees will have completed the CHS and departmental orientations, as well as a core competencies checklist and training in their primary area, she adds. "As they progress, they will want to master [other registration areas], but at this level, they should show some interest [in those areas] or maybe work there for a couple of days." These employees also should be sure to participate in continuing education classes, Davis says, such as advanced Medicare Secondary Payer (MSP) training or advanced insurance training.

Level Two Registrar

To move to the second level, she explains, a registrar must meet the following requirements:

  • Have been a full-time employee in his or her current department for at least a year
  • Received an "exceeds expectations" on the annual performance review, which is based on quality assurance (QA) and productivity
  • Received no verbal or written disciplinary counseling in the past 12 months
  • Cross-trained in two additional areas in his or her own facility or cross-trained in another Carolinas HealthCare hospital (For example, a registrar who works in the outpatient area at one hospital could cross-train in that facility’s emergency department, and in the outpatient area at another facility.)
  • Successfully completed at least two continuing education classes in the health system’s training program or from an approved outside institution
  • Taken and passed a Registrar Level Two exam, prepared by Davis and other patient access executives ("It consists of 50 questions, randomly selected from a total of 120 questions," she adds. "If 10 people take it, no two tests are the same.")

In addition, Davis says, "Level Two employees are always expected to conduct themselves in a courteous and professional manner. Once they get to that level or to Level Three," she adds, "they have to recertify each year."

A study guide is available for those aspiring to the Level Two designation. If at any point an employee gets a written reprimand, he or she can lose the Level Two designation, Davis notes.

Level Three Registrar

To attain the Level Three designation, registrars must meet all the requirements for Level Two, including cross-training to additional facilities and working at those facilities, if needed. In addition, they must do the following.

  • Work in the department for at least two years, meeting the necessary quality and productivity standards
  • Have experience doing charge duty or acting as lead registrar
  • Sit for and pass the certified healthcare access associate (CHAA) examination offered by the National Association of Healthcare Access Management (NAHAM)
  • Cross-train in three additional areas or facilities.
  • Take at least four new continuing education classes within the past year

Salary range doesn’t change

A registrar’s salary range doesn’t change as a result of attaining a Level Two or Level Three designation, Davis points out. Rather, the financial benefit comes through the organization’s monthly incentive program, which is geared toward team recognition.

For a registrar to be individually eligible for the program, he or she must be beyond the 90-day probationary employment period, and must have worked at least 120 hours during that month if a full-time employee, and at least 60 hours if part-time, she explains. In addition, the QA score for the facility at which the registrar works must be at a certain level.

If the QA score for the facility is between 95% and 100%, Davis says, Level One registrars who also meet their individual goals receive a bonus of between 2% and 7%; Level Two get between 5% and 10%; and Level Three are given between 7% and 12%. "The lowest we go is 95% for the facility score," she adds. "If it’s less than that, no one is eligible."

Individually, the registrar’s monthly QA score must be 97% or better, with a minimum productivity score of 91%, Davis notes. "The registrar can have no more than one MSP error, one duplicate unit number, and one self-pay error for the month."

In addition, she says, the person must meet the established upfront collections guidelines for the department and can’t have received any disciplinary action during the month. "This has been a good incentive for those who want to advance," Davis says. "The [Level Two] exam is given by the training director, and she schedules them quarterly. Those who pass get a nice certificate, and we make a big deal out of it."

For the first time in 2004, the department had a registrar attain the Level Three designation, she notes. "The first person sat for the CHAA exam, given by NAHAM in May, and found out in June that she had passed."

[Editor’s note: Katie Davis can be reached at (704) 529-2401 or by e-mail at]