New access career ladder reflects industry changes
Specific skill sets emphasized
A new access career ladder is in the works at Borgess Medical Center in Kalamazoo, MI, one designed to reflect increasing revenue cycle demands while maximizing employees' individual strengths, says Jean Ware, CHAM, director of patient access services.
Although a career ladder implemented in 2001 was still in place as of early 2006, she adds, "we are now at the point of revising the program and rewiring our job descriptions because we are asking more of our access staff. We are shopping for specific skill sets."
"We have been working [on the new career ladder] since March 2005, and are hoping to roll it out by the end of March 2006," Ware says. "The biggest challenge has been working with our human resources department to make sure that as we are hiring new talent and promoting existing talent, we are doing it in a way that is fair, but is also giving people the capacity to grow."
What came before
The career ladder instituted in 2001, she explains, was created in response to a situation that developed after access employees at the 425-bed hospital were grouped under one primary job title: business associate. In addition to registration and insurance skills, Ware says, the title encompassed unit control functions at the hospital's different care centers.
"The [business associates] were supposed to be experts at all of that," she says, "but over time this big grouping of business associates never became a fully developed model of 'one person does it all.' There was low accuracy in the access role.
"We merged all the roles in 1995, and we started working on the career ladder in 2000, so we tried for five years," Ware adds. "There were competing priorities for these unit clerks. It was very difficult for them to perform the job when they were supposed to do access functions as well as things like paging physicians, entering orders, watching the call lights and the telephones, and running the bed board."
In 2000, she says, the idea was to create "avenues for staff to strive for something more, to look for another goal, so that cross-trained folks actually are paid for what they do."
The resulting program, Ware continues, requires business associates who want to be part of the career ladder to prepare a portfolio including: a letter stating their desire to participate; a resume; a peer evaluation; their most recent performance review; a self-evaluation, including what they perceived to be their strengths and weaknesses; and three evaluations from anyone they considered customers, such as a nurse or a supervisor.
Also required in the portfolio, she says, are a checklist about skills and another about teamwork and leadership, an attendance record, and an education/training record. The person also must score 90% or better on a registration accuracy exam, Ware adds.
Successfully completing the above, she notes, along with holding the job for at least a year, qualifies a person for level one of the ladder. Outstanding employees may become part of the ladder in less than a year at the recommendation of a manager or supervisor, Ware says, but that is rare.
To qualify for level two, the employee also must be a preceptor, with experience training new employees and score 90% or better on another, more in-depth exam. That exam, which includes customer service, medical terminology, registration, billing, insurance verification, and finance components, is more focused on critical thinking and interpretation, she adds.
Employees can go "from ground level to level two" if they meet the necessary requirements, including the year of service, she says.
To attain level three, employees are required to pass the certified health care access associate (CHAA) exam offered through the Washington, DC-based National Association of Healthcare Access Management (NAHAM), Ware says.
They also must complete some DiSC workshops (which provide feedback on behavioral tendencies and identify an individual's strengths and weaknesses) on project management training, she notes, and function as resource people for their peers. To qualify for level three, Ware adds, employees must have worked for the hospital for at least three years.
Each level attained, she says, represents a 3% increase from the base pay scale.
What's next?
What is happening now, as part of the "rewiring" of job descriptions to match the increasing demands placed on access staff, Ware says, is that "instead of putting people through a cookie cutter, we want to hire for certain skills."
While business associate had a very broad job description, she notes, the department is now looking at dividing the access function into three categories when interviewing potential new hires:
1. Patient access associate (skilled in registration, customer service, and reception), with two levels of expertise.
2. Patient access insurance specialist, with three levels of expertise, the top level being "patient financial advocate."
3. Patient access scheduler, with two levels of expertise.
"We will be hiring with one of those categories in mind," Ware says. "There are some staff right now who are at 'level three business associate' who know two of those roles. Their opportunity is greater than someone who fits into only one category."
Employees with those dual skill sets will be compensated accordingly, she adds.
Someone who attains the "level two patient access" also might have insurance verification skills and so is, in effect, cross-trained, Ware says. "There are schedulers who can do registration and reception, so they also fall into two categories.
"We are making the job descriptions broad enough to encompass situations in which someone comes from the outside who has more insurance verification experience, but is also skilled in other areas," she says. "They might fall into insurance level one, and so some functions that cross into level two, but they will be placed in a role according to what they do the most and paid according to what they know."
Under the new system, Ware explains, about half of the business associates, or about 60 employees, will fall back under patient access, performing registration, insurance verification, scheduling, and financial counseling duties.
The other half of the business associates will remain in the care centers, serving as health unit coordinators, she says. Their job descriptions, which no longer include access functions, will also be redesigned, Ware notes. "There will be a similar career ladder for them that is specific to the care centers."
Among the operational changes that have influenced the staffing adjustments, she says, have been the merging of some care centers — medical and surgical units are now combined, for example — and some realigning of leadership.
A twofold interview process
Finding allies in the HR department and working change from that angle has been an important part of creating the new hiring and promotion model, Ware says.
"Traditionally, I think HR looks at resumes and places people in positions based on a score card," she adds. "We want to have more control over emotional intelligence, so we are looking at the interview process as twofold. HR might say, 'She's got all this experience,' but we as managers and directors are taking a different approach — we want to align people with skill sets and job descriptions."
A good approach is to be more actively involved in the screening and interview process, Ware suggests. "We do panel interviews and 'score' candidates out. I have four managers. We look at the needs we have and, if a person seems like a great candidate and we don't have a vacancy in that area, we look at whether we have flexibility in cross-training, so we don't miss out on good talent.
"Get away from the cookie-cutter mentality," she advises, "to a process where you make sure the person's skill set aligns with the position, instead of forcing [the individual] into a position that doesn't allow her to do what she does best. So it's being flexible."
[Editor's note: Jean Ware can be reached at (269) 226-8393 or by e-mail at [email protected].]
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