Every industry, from healthcare to food service, has felt the strain of employee recruitment and retention over the past few years. Employees who were left with a short-staffed team have experienced increased burdens, and consumers have experienced a decline in service levels. In healthcare, our consumers include everyone from patients and their family members to insurance companies, hospitals, referring providers, and even members of internal departments. Therefore, we owe it to our workforce and consumers to build the best possible revenue cycle management (RCM) team.
Recruiting the Ideal RCM Team
Recruiters are the backbone of ensuring a solid RCM team. In many medical practices, the office manager performs recruiting duties, along with his or her other leadership tasks. Although it is not required for a recruiter to be an RCM expert, understanding the characteristics needed for a successful revenue cycle plays an important role in cultivating the best team. Having additional insights and knowledge of a successful revenue cycle will foster a recruitment process that utilizes effective screening strategies to eliminate individuals who may not be a good fit, while advancing qualified individuals to the next level.
There are many factors to consider during the applicant screening process. Will the position be in-office or remote? If it is the latter, does the individual have secure home office capabilities? Experience with optimizing electronic medical records can be helpful for justifying billed services. Knowledge of practice management software efficiencies can be useful for minimizing manual processes that could be automated. Clearinghouse optimization skills can be valuable for scrubbing claims and validating insurance information prior to submission. Experience with payer portals is helpful for keeping provider profiles updated and minimizing inaccurate information. Prior experience with a specific medical specialty will result in a better understanding of disease-specific treatment and payment rules. Knowledge of commercial payer reimbursement guidelines, regardless of medical specialty, can be useful for interpreting denials and adjusting claims accordingly. Experience with state Medicaid and local Medicare Administrative Contractors lessens the learning curve and increases compliance with complex payment rules.
It is also important to understand the mindset of today’s candidates regarding needs and expectations that have arisen because of the COVID-19 public health emergency. During the recruitment process, we should explore the motivations of applicants and the methods they use in their job searches.
For example, according to the results of a large LinkedIn survey of more than 14,000 professionals,1 job candidates said that the most useful information to obtain from interviewers was role responsibilities (70%), followed by how they fit with a team (42%), company mission and vision (42%), salary and benefits (39%), and advancement after role (31%). The survey results also showed that the most common ways that job candidates learned about a company's culture was through an office visit (51%), from a hiring manager (50%) or other employees (46%), through a company's website (27%), and from recruiters (24%).
Selecting the Right Fit
RCM team members are not limited to the billing staff and may include individuals who have an impact on the revenue cycle, such as front desk workers, prior authorization specialists, and medical coders. The importance of selecting the right fit for the RCM team cannot be overstated. Although it is not possible to determine how successful teams will be until they begin working together, you can leverage the selection process to improve your chances.
Excellent communication skills are critical to the success of an RCM team. During the recruiting process, consider the communication flow for each new team member and prepare them for success by mapping what has been gathered about their communication style with the known communication patterns of the current staff. Some aspects of RCM communications flow are shown in the Figure.
It is important to ask incoming team members specific questions regarding communication patterns to avoid gaps that may lead to frustration or RCM bottlenecks. This is especially critical if some employees are working in the office while others are working remotely. If new billers who will be working from home are hired, it will be necessary to implement strategies to introduce them to office-based team members. This will help to build trust and establish a good rapport. If remote billers have questions regarding the data entry of demographic information that is affecting a claim status, they will want to communicate with the front desk staff, whom they do not routinely see face to face. The goal of screening incoming team members regarding their communication patterns in various scenarios is to minimize adversity by streamlining and improving communication.
Cultivating the Strengths of Your RCM Team
No matter the industry, we are all vying for the strongest and most sustainable workforce; however, there are unique needs required by an RCM workforce to be successful. As we seek to attract and retain the brightest teams, let’s consider identifying the threats and vulnerabilities to the revenue cycle and map those to skills needed to overcome these threats (Table).
The skills required to overcome RCM threats are at the heart of revenue integrity. Selecting team members who value the importance of revenue integrity will be key to building a stellar team. According to a report by the Revenue Cycle Advisor, “The National Association of Healthcare Revenue Integrity states that the basis of revenue integrity is to prevent recurrence of issues that can cause revenue leakage and/or compliance risks through effective, efficient, replicable processes and internal controls across the continuum of patient care, supported by the appropriate documentation and the application of sound financial practices that are able to withstand audits at any point in time.”2
There are a few key characteristics that healthcare leaders look for when cultivating high-performing RCM teams. We love the “squeaky wheel” because this individual “gets the grease.” He or she is not going to just sit back and let the chips fall where they may. The squeaky wheel is going to speak up and highlight problems that require a resolution. Leaders are well advised to interpret the “complaints” from the squeaky wheel to glean insights into behaviors, workflows, and inefficiencies that may create bottlenecks in the revenue cycle.
On many RCM teams, we have a “compliance guru”—this is the person who does everything by the book. We need this type of individual not only to seek out a thorough understanding of guidelines but also to ensure that his or her peers, and the organization as a whole, are complying. The compliance guru keeps organizations from unintentionally running afoul of laws and regulations.
Having a “detective” on the team is also a huge value add. Someone with this personality is deeply interested in problem-solving and will investigate deeper than surface level to find answers. Since there are many complex and even overlapping guidelines related to RCM, the goal of the detective is to unravel mysteries.
It is important to remember that team members are looking for their efforts to be recognized and appreciated. Squeaky wheels want to be heard; when they bring concerns to our attention, the worst thing we can do is to ignore them. Compliance gurus will feel a sense of recognition when they are included in policy changes. Delegating problems to detectives can help to keep them motivated. Encouraging the positive characteristics of these personality types will allow them to flourish, which will also benefit the organization.
It takes time to cultivate a successful RCM team. However, when this is done correctly, the result will be increased employee satisfaction, which will ultimately improve your bottom line. Take lessons learned from your workforce to devise a successful recruitment process that will yield a strong and sustainable RCM team.
- Reilly K. 5 insights from LinkedIn’s latest research on what candidates want. July 24, 2017. www.linkedin.com/business/talent/blog/talent-strategy/linkedin-new-research-inside-mind-of-todays-candidate. Accessed April 21, 2023.
- Revenue Cycle Advisor. Core functions of revenue integrity. January 3, 2018. https://revenuecycleadvisor.com/news-analysis/core-functions-revenue-integrity. Accessed April 21, 2023.