Hiring Strategies

HEALTHCARE REGISTRATION APRIL 2010
PAGE3
Patient Access Excellence:
Hiring Strategies
An occasional series on patient access human resources issues
I t is a given that the health care industry is ripe for
job growth, based on the most recent labor data
from the federal government and based on current
employment surveys. 1 Even absent job growth,
however, patient access tends to have a high degree
of turnover, so hiring new employees is a task that is
consistently in the mix for patient access leaders.
In this article, Michael Friedberg offers guidance
for effective hiring strategies, plans, and processes. The
reason it is essential that patient access directors and
managers develop and hone hiring plans and processes
is that the position of patient access representative
is a highly complex role that pays about the same
as a retail clerk. Thus, it is critical that managers seek
employees who are motivated by challenge more so
than pay. And there are individuals who would prefer
to take a position that pays the same as a retail clerk but
offers more of a challenge. You just have to find them.
Recruitment Strategies
Many patient access managers and directors do not
rely solely on a hospital’s human resources department
to provide them with resumes of good, qualified
candidates. Even under the best circumstances, it is
difficult to find the right people with the right skill sets
to fill the position of patient access representative.
Someone once said that “necessity is the mother of
invention,” and hiring staff for positions within patient
access is no exception. Patient access directors often
need to use creative problem-solving skills. We can all
think of examples of workarounds created to compensate
for an unchangeable characteristic of our information
system. Although this is not the preferred method,
sometimes such workarounds become necessary.
Taking a workaround approach in hiring, however,
can be problematic. Yet, finding the right person to
fulfill the role of a patient access representative can
be difficult, and patient access leaders are sometimes
guilty of hiring a candidate who is not optimal for
the position just to fill a void in the department. This
makes everyone’s job more challenging.
To avoid just plugging a hole and instead focus on
hiring right, patient access leaders need strategies to
identify and recruit candidates. Following are some
good strategies for finding the right type of person to
fill a patient access position.
Seek Referrals from Existing Staff
Seeking referrals from existing staff can be a
double-edged sword, depending upon who makes
the referral. Nevertheless, taking this route works out
more often then it blows up.
Most mature and effective staff members would
not consider recommending someone who would
cause them embarrassment. In addition, employees
© 2010 Aspen Publishers.
All Rights Reserved.
Editor:
Laura J. Merisalo
Phone/fax:
414-258-1797
e-mail: hcr@wi.rr.com
To subscribe:
Call 800-638-8437.
For customer service:
Call 800-234-1660.
Publisher
Paul Gibson
Senior Managing
Editor
Joanne Mitchell-
George
Managing Editor
Elizabeth Venturo
Marketing Director
Dom Cervi
Healthcare Registration
(ISSN: 1060-0434 USPS 017461)
is published monthly by Aspen
Publishers, at 76 Ninth Avenue,
New York, NY 10011. This material
may not be used, published, broadcast,
rewritten, copied, redistributed
or used to create any derivative
works without prior written permission
from the publisher.
Postmaster:
Send address changes to Health
Care Registration, 7201 McKinney
Circle, Frederick, MD 21704.
Subscription price:
$499 per year plus postage, handling,
and appropriate state sales
tax. Single issue price: $50.
Business and circulation:
Fulfillment Operations, Aspen
Publishers, 7201 McKinney
Circle, Frederick, MD 21704.
Permission requests:
For information on how to obtain
permission to reproduce content,
please go to the Aspen Publishers
website at www.aspenpublishers.
com/permissions.
Purchasing reprints:
For customized article reprints,
please contact Wright’s Reprints
at 1- 877-652-5295 or go to the
Wright’s Reprints website at
www.wrightsreprints.com.
APRIL 2010 HEALTHCARE REGISTRATION
PAGE4
currently performing the functions required by a
patient access representative are in a good position to
determine whether a person they might recommend
would be good at the job they perform.
Connect with a Career Center at a Local
College or University
College students are always looking for work—both
full- and part-time—especially if it will give them experience
in a field they intend to enter upon graduation.
Indeed, Friedberg notes that some of his patient
access hires went on to become doctors, nurses, paramedics,
and physical therapists. Some even took time
to tell him that working in patient access gave them
a better appreciation for supporting administrative
staff members.
The downside to hiring college students is that they
most likely will serve as part of the department for a
limited amount of time, usually a maximum of four
years. If, however, you are able to find a few reliable,
efficient, and hard-working students as staff members
who may need to be replaced every few years with
other job-seeking college students of similar caliber,
the tradeoff is worth the effort.
Prior Health Care Experience Is Not
Required
Everyone has to start somewhere, and, for most of
us, someone at some point took a chance and hired us
even though we did not have experience. Some of the
most important skill sets for a patient access representative
consist of the ability to perform the same task
over and over, to handle pressure, to understand complex
computer systems, to work as a “people person,”
and to be comfortable around people with medical
issues or problems, including emergency situations
where blood and bodily fluids are present. Other skills
sets—such as computer system competency—can be
taught.
Seek Candidates with Experience in Other
Industries, Especially Service Industries
Friedberg notes a colleague who will pass a business
card to a waiter or waitress who has provided
her with excellent service. In addition, hotel desk
clerks and amusement park employees can make
good patient access employees as they come from a
customer service-focused environment.
Attract Good Employees by Being
a Good Employer
Many hospitals must draw candidates from their
local community, as few individuals are willing to
commute an hour or more to take a job in patient
access if they can work in their own area. If a provider
organization develops a reputation as a good place
to work, however, top-tier potential employees will be
attracted to pursue jobs at such a facility, as these candidates
desire to work for organizations where hard
work is appreciated and rewarded.
Your Department Is Your Best
Advertisement
When patients, visitors, and others enter your
department, are they greeted immediately? What does
the physical appearance of the work area say? Are
desktops messy and disorganized? Is reading material
available for patients while they wait? Are the magazines
current, or are they outdated? People take note
of such details, consciously or otherwise. Remember
that anyone who enters your department—for any
reason—is a potential employee.
Front-End Salary and the Great Debate
One of the great debates in health care management
springs from the question, “What motivates
employees?”
Friedberg believes that what motivates employees
is a combination of factors, including salary, benefits,
work environment, pride in work, recognition for a
job well done, and advancement opportunities. Yet,
Friedberg is baffled by health care providers who do
not want to be the highest payer in their geographic
area. If you strive to be the best clinically and have
state-of-the-art equipment, wouldn’t you want the best
staff to use these devices? Even though salary is not
the sole motivator for good employees, lower-level
employees are more motivated by salary than higher
compensated staff. Consider: The difference between
$10 per hour and $12 per hour is 20 percent, while the
difference between $25 per hour and $27 per hour is
8 percent.
Staff is the greatest expense within any health care
facility, and the ability to maintain that cost at current
levels while revenue shrinks is a challenge facing management.
Failure to invest adequately and appropriately
in patient access staff, however, can lead to errors
that add significant cost to the ability of providers to
obtain payment for services provided.
It is frustrating for patient access managers to
watch as resources are added in patient accounting
and medical records but not to patient access. This
trend seems to be turning, as many providers are now
realizing the value of “getting it right up front.”
Job Descriptions
Most managers do not spend a large amount of
time reviewing job descriptions and matching them
HEALTHCARE REGISTRATION APRIL 2010
PAGE5
to the work employees actually perform. There is,
however, no other mechanism to concisely explain
job expectations to a potential employee without this
document.
Some providers are better than others at maintaining
job descriptions that match actual tasks performed.
Others rely on the catch-all phrase “any
other duties as assigned by the supervisor, manager,
or director” in order to ensure that employees need
to respond to their supervisors.
Regardless of which category your organization may
fall into, remember that it is in your best interest—
and in the best interest of future employees—to
clearly explain (to the best of your ability) the job
expectations and the role a future employee will fill
in the department. These expectations should be
clear and outlined early, starting with the interview
process and continuing throughout initial training
and, eventually, during the performance evaluation
process.
Interviewing Candidates
There are several schools of thought on who
should conduct candidate interviews. Some employers
will arrange for interviews with current staff members
as well as members of the management team.
Involving front-line employees in the interview
process can be useful, as candidates often let their
guard down when they are not interviewing with a
manager or a director. For instance, candidates may
inquire of potential future colleagues about time off
policies or how heavy or difficult the workload is,
queries they may withhold during interviews with a
potential supervisor.
There are many interviewing strategies. Some key
interviewing issues to address: create a standard candidate
evaluation form to be used by supervisory and
front-line interviewers, conduct multiple interviews,
and ask the right questions.
Use the Same Candidate Evaluation Form
The live interview is a time for interviewers to
determine whether the person on paper matches the
person in the interview. In addition, interviews present
an opportunity to determine whether a candidate
will fit in with the culture of the department and of
the organization.
All involved in the interviewing process, however,
must use the same candidate evaluation form
so that there is a consistent method for evaluating
potential new hires. This method also allows all of
the interviewers to sit together and discuss potential
candidates knowing that they all used the same methods
and asked the same questions. This technique is
particularly useful when a large number of candidates
will be interviewed for a position, as it allows everyone
to keep track of who they met and how they measure
up, based on the same interviewing criteria.
Conduct Multiple Interviews
Each candidate should have a minimum of two
interviews on two different days. This is an absolute
rule, as the second interview will allow you to determine
whether the candidate can arrive on time and
act appropriately more than once.
Because patient access jobs typically are entry-level
positions, layers and layers of interviews are not necessary.
When there is a need to hire people with specific
knowledge, such as supervisors, insurance verifiers,
and financial counselors, the number of interviews
and interviewers may expand.
Ask the Right Questions
There are any number of questions to ask during
an interview, and following are 15. It is important
to note, however, that a candidate’s response to any
given question should not be considered in a vacuum
but rather in the context of the overall interview.
1. Ask the candidate to give a brief description of
himself or herself. Listen carefully to the answers,
as the first response someone provides to any
question is a good indicator of his or her character
and true feelings.
2. Ask candidates about past positions. Determine
whether their prior experience and skills fit with
the parameters and needs within the department.
3. Ask candidates why they left their last position.
If they state that they were not making enough
money, you know money is their main motivator.
If they state they could not get along with their
supervisor or that their supervisor hated them and
made their life difficult, consider this a potential
red flag, as it may be a sign that someone has trouble
dealing with authority figures. Note: There are no
absolute rules, and supervisors are not always right. A
supervisor could pick on an employee even though he or
she had excellent work performance.
4. Ask candidates some variation of the questions:
• “What are your biggest strengths?”
• “What are your biggest weaknesses?”
APRIL 2010 HEALTHCARE REGISTRATION
PAGE6
If they say their biggest weakness is that they are
easily bored and struggle to do the same task
repeatedly, you know they may not be the right
candidate for the job.
5. Ask candidates to rate their work performance.
Some people ask the candidates to rate their work
performance on a scale of 1 to 10. If candidates
do not give “10” as an answer, ask why. Carefully
consider their answers to these questions. If they
tell you that their work performance is a nine,
they might not rate themselves a 10 because they
feel that they can always improve.
6. Ask candidates to relate a proud customer service
experience in which they were involved as an
employee. If they cannot come up with an example
of how they provided good service, consider
this a potential indicator that they are not providing
top-notch service.
7. Ask about short-term and long-term goals. You
may find that candidates who indicate that they
are looking for a foot in the door so that they
can eventually transfer to another department
may—or may not—meet your needs.
8. Ask candidates some variation of the question:
• “How would you deal with a difficult customer?”
9. If yours is a 24/7/365 department, ask candidates
when they are willing to work. If they are only
available Monday to Friday from 9 a.m. to 5 p.m.
and the position requires that employees rotate
into weekend or evening shifts, this must be
addressed with the candidate. Also, be aware that
many candidates will say that they are willing to
work any shift, any day, any time. This is not always
the case, however, so prepare for them to decline
your offer if they are offered nights.
10. Ask whether the candidate has any special
restrictions. This query is not intended to exclude
candidates, but to determine how special restrictions
can be managed. For example, if a candidate
says he takes care of his sick parents and must be
home to give them medicine every day at 7 a.m.
and so cannot be to work until 9:30 a.m., you know
you will need to be flexible on the start time if the
candidate would be a good addition to your team.
• Further, once employees establish themselves
as reliable, managers must remain flexible.
Daycare arrangements sometimes fall through
at the last minute, employees or employee
family members may get ill, and other life
issues can occur, so making accommodations
for valued employees also must occur from
time to time.
• Friedberg notes that he is an advocate of being
a demanding but compassionate employer,
which has served him and the organizations
where he as worked well. If someone works
hard, Friedberg says, he would want to do
whatever is needed to help an employee. He
notes that he has, on occasions, contributed to
the cost of funerals for employees who could
not afford to bury a loved one, helped battered
women protect themselves from future
abuse, and helped employees obtain psychiatric
help as well as rehabilitation from drug
and alcohol abuse. Such supportive efforts for
dedicated and effective employees are worth
the effort to retain talent.
11. Ask candidates what they expect for a salary. If the
hourly rate is $10 per hour and a candidate will
only accept $15, the interview can be shortened.
Sometimes when you attempt to close an interview
due to the disparity in salary desired and salary
being offered you may learn that $15 is what they
desire but not what they are ultimately willing to
accept.
12. Ask candidates what energizes them in the work
place. The ideal response is one that indicates that
the candidate is energized by the satisfaction of a
job well done or by the ability to help people in
need. As in grade school, if the answer is lunch,
that is a likely indication that the candidate and
the department may not share the same values.
13. Ask what the candidate expects from a manager/
supervisor. This question can also help you understand
whether the candidate struggles with taking
direction.
14. Ask candidates why you should hire them above
all the other candidates. This is another variation
on the question to rate their work performance.
15. Ask candidates if they have any questions. If the
candidate does not ask any questions, consider
that a red flag. If you spend time with a potential
candidate and explain the many, varied, and often
complex requirements of a position in patient
access, this should trigger at least one question or
need for clarification. Notes Friedberg, “I would
rather a candidate ask a question with an obvious
answer than ask no questions at all.”
HEALTHCARE REGISTRATION APRIL 2010
PAGE7
Conduct Initial Competency Exams
After the interview portion is completed, give the
candidate initial competency exams.
The exams should cover, at minimum, the following
topics:
• Computer literacy;
• Standardized typing;
• Customer service; and
• Software specific competencies.
Computer Literacy
A basic understanding of how to use a personal
computer is essential. Although employees can be
trained on more complex computer functions, candidates
should be tested to determine if they can handle
basic PC navigation.
Standardized Typing
Avoid hiring candidates who type fewer than 30
words per minute accurately, as they will struggle to
maintain productivity standards.
Customer Service
In conjunction with answers given during the interview
process, test for candidates’ ability to effectively
manage basic customer service issues.
Software Specific Competencies
Competency exams in this area will depend
upon the systems and skills candidates note on their
applications. If a candidate notes experience with the
system used by your facility, a brief exam on core system
competencies may be worthwhile.
Keep in mind that prospective candidates sometimes
embellish their credentials because they believe
it will help them get the job and that they can figure
out later the skills they promised to deliver. It is better
to discover a talented candidate in all areas but
software-specific skills, as those skills can be taught.
Friedberg notes that it can be a positive if a candidate
lacks experience on your specific system, particularly
if a candidate says, “I have never used XYZ Software,
but I have used similar software, so I am confident
I can quickly learn the ins and outs of the XYZ
Software.” ■
Note
1. “Health Care Offers Greatest Job Growth Through
2018,” Healthcare Registration , March 2010, vol. 19, no. 6,
pp. 8–10.
This article is another in an occasional series on
patient access human resources issues, from initial
hiring and training, through to quality assurance
and retraining. The guidance is excerpted with
permission from “Staff Competency in Patient
Access: Tools, Tests and Tips for Building a
Successful Team,” by Healthcare Registration editorial
advisor Michael S. Friedberg. For more information,
go to www.hcmarketplace.com.
Reeaaddeerr’’ss RReessoouurrccee
Boost Bottom Line, Morale,
Patient Satisfaction
with Gratitude
Cultivating an attitude of gratitude culture
Liz Jazwiec
D oes your organization encourage a culture of
gratitude? Not in an obligatory, “Gee, I really
appreciate my coworkers and the feeling is
mutual!” way? Chances are the answer is no.
According to a recent Gallup poll, 65 percent
of people say they don’t feel appreciated at work.
And that feeling can lead to pervasive negativity, low
morale, and (worst of all) decreased productivity.
Copyright of Health Care Registration: The Newsletter for Health Care Registration Professionals is the
property of Aspen Publishers Inc. and its content may not be copied or emailed to multiple sites or posted to a
listserv without the copyright holder's express written permission. However, users may print, download, or
email articles for individual use.