Revenue Cycle

PARC FEATURE STORY: People skills first

Patient Financial Services Weekly Advisor, March 28, 2008

Accuracy, production take a backseat to a smile and a good impression

Accomplishing registration accuracy, check. Understanding how to deliver an advance beneficiary notice, check. Handling a phone call from a patient, check.

A patient access representative needs to be competent at performing all of the above.

The burden to train representatives falls on the access manager. When representatives fail to meet expectations, the access manager must take the time to revisit training.

But can good customer service skills be taught, or are some people naturally inclined to communicate effectively with others?

Although the debate about whether these skills are learned or innate continues, there is no debate about the importance of patient access representatives possessing customer service skills. And there is certainly no denying the importance of people skills in a children's hospital.

Nervous parents with sick children need access representatives who are calm and comfortable.

Access managers say the person behind the admitting or registration desk must remain calm, understanding, and focused no matter what is thrown his or her way.

Look for people skills

"The biggest thing we look for is good customer service," said Jo Ann Tomes, manager of admitting at Cincinnati Children's Hospital Medical Center. "When I interview somebody, I'll look for somebody who has a strong handshake and is up and bubbly. People are nervous when they go through an interview. You can tell if people are good with other people. You can teach people anything, but it's difficult to teach them to be nice. I don't care how much customer service you have; it's difficult to teach customer service."

Once candidates are invited to come for an interview, Tomes says she looks at everything from their extracurricular activities to what they do with family and friends.

"A lot of times, we have students as applicants," says Tomes. "We get college students, and we watch to see how outgoing they appear. If they answer me with one word, I have a concern with their ability to interact."

Cincinnati's training process begins with a hospital orientation and three days in the admitting department to talk about registration. Trainers from the billing side and registration help.

Next, new representatives go to a training center for four days, where they set up their computers and get used to the system. "That's the best part-they can actually [use computers and learn the system]," says Tomes.

The representatives then go through a few more weeks of training with the admitting staff before they go live on the floor. There are also ongoing programs available within the organization to help improve their skills.

Then the first big test comes. How will the representatives handle tense situations involving sick children?

One of the most important things, Tomes says, is to stay calm.

"That's probably one of the things we emphasize during their training," Tomes says. "If you get apprehensive, nervous, and upset, then you're going to upset the family. You have to keep in mind you're trying to calm them down. You do what you have to do and get them where they need to go. Just make sure they're comfortable with you. You just have to know [good customer service]."

Make the job fun

At Phoenix (AZ) Children's Hospital, part of the training process involves teaming up with a buddy or mentor.

Learning how to register is one thing, but the buddy system seems to help new representatives learn the real ins and outs, such as customer service skills, says Irma Becker, the revenue cycle manager of patient access at Phoenix.

"Customer service is a key," Becker says. "You can't be squeamish, and you have to have a lot of compassion. I don't look for experience. I want people who are customer-service oriented."

The access representative also has to be a person with thick skin, Becker says. They must deal with a lot of folks in the hospital, from custodians to clinicians. Access staff members cannot get ruffled when the going gets tough.

"It's not an easy job," Becker says. "You have to go down different avenues looking to see how you can refresh the staff. If you got a registration representative who is brand-new and her attitude is just wonderful, it tends to affect the other coworkers. You as the manager have to find ways to make the job fun again. They have to know how to respond to doctors and nurses who are stressed out. It's the most difficult job in finance. When they need a scapegoat, they say admitting did it. If they don't register right, the hospital doesn't get paid."

Tracy Walsh, LCSW, director of patient access and case management at Vail (CO) Valley Medical Center, says that the first impression the access representative makes on her is probably similar to the one he or she makes on patients.

"I think that I have learned over the years that you can teach technical skills," Walsh says. "You can't teach a person to be nice. We utilize a company that tests for these types of things prior to hire . . . It is interesting how a person might portray themselves in the interview and then when they take a test. It is like you have to go on your first impression of the person, because that is what your patient will see."

T. T. "Mitch" Mitchell of T. T. Mitchell Consulting, Inc., agrees that it is all about the first impression.

"When a patient comes into a hospital, usually the first people they see are the registration or patient access people," says Mitchell. "This means that their impression of the entire experience begins with them, and thus, it's critical that their customer service skills are outstanding and their knowledge impressive. If registration goes bad, in the patient's eyes everything else is bad also, because, as I like to say, no one ever comes to the hospital because they wanted to." 

Editor's note: This article is part of the Patient Access Advisor's ongoing series, A-Plus Access, which focuses on enhancing professionalism among access staff members.


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