As many as 75% of the total U.S. workforce will be comprised of the millennial generation by 2025. This brings with it a variety of shifts in recruitment, training, and retention practices, as well as the general attitude towards work and career. In a poll of more than 3,500 revenue cycle leaders by the staffing agency LaSalle Network, 79% of these professionals said they have received at least one job offer this year and 81% were open to new opportunities. Gone are the days when employees are devoted to one organization throughout their careers.
In the current era, it’s not only difficult to retain talented and in-high-demand staff, but they also desire to feel invested in before they will invest their own time and efforts toward company growth. To date, revenue cycle leaders reported compensation and lack of career growth among the top reasons for turnover within their departments. In examining various career progression models across revenue cycle departments and health systems, HBI has come to find that when done strategically, they may present the best chance to attract younger talent, overcome recruitment challenges, improve retention rates, all while developing the skills and knowledge of its existing staff.
Here are some “dos” of a successful revenue cycle career ladder:
- Integrating education with advancement: With the departure of one employee comes the process of identifying, hiring, and training a new candidate—this is in addition to losses in productivity and revenue for the employer. To address this turnover, organizations are integrating education curriculum into the career progression that increases in complexity with advancement. In some cases, the scope of education will expand to include revenue cycle areas outside of their own. This strategy often entices committed staff members to enhance their skillset or obtain professional certification to move ahead within the organization.
- Setting and conveying the expectations clearly: Typically, a departmental career ladder has three to five rungs, and for each level, there is a higher set of criteria for meeting or exceeding expectations of accuracy, productivity, code of conduct, years of experience, certification, and/or demonstrated skills. This necessitates expectations to be clearly defined and regularly communicated to staff by senior leadership. Among our membership community, we have seen this done via new-hire packets, goal sheets, competency checklists, one-on-one rounding sessions, and more regular feedback.
- Associate compensation with achievement: The biggest source of dissatisfaction reported within annual employee surveys is salary, and in some cases, staff may leave for another department or practice to obtain better hours for the same or more pay. To address this, healthcare organizations are linking incentives or an increase in compensation with each career ladder level and the completion of affiliated curriculum. An HBI review on pay structures associated with revenue cycle career ladders revealed that organizations increase compensation for eligible staff members by 5-7% at each level. In some cases, a 2% increase represents merit and the additional 5% is meant to reflect increased responsibility, skill, and education.
- Breaking down the barriers: As the revenue cycle evolves and grows in scope, traditional silos are coming down. This only emphasizes, however, how organizations and their staff are continually expected to do more with less time or resources. For this reason, organizations may want to utilize career ladder pathways to feed staff into more difficult-to-recruit or highly complex roles, or perhaps where there is the most turnover in the organization. For example, a California-based organization created a career ladder for both professional and facility coders wherein the highest (fifth) rung is a revenue integrity analyst position. This means only certified coders with more than five years of experience make it into the role. HBI has also seen future-forward leaders consider career ladders that start in one area (e.g., scheduling) and end in another (e.g., customer service).
- Engaging Staff in career development and maintenance program: To promote staff participation, it is vital to establish accountability at all levels. Organizations can set retention or staff engagement scores as an annual performance review cornerstone for senior management. This tactic should be paired with increased efforts to seek feedback from employees on opportunities, training, and curriculum early and often via anonymous surveys, in-person interactions, and online discussion boards.
- Make it voluntary: In some cases, employers may require that all staff move up a level or complete certain education sessions and competency exams within one year or so of employment. However, not all staff desire rapid advancement and allowing for voluntary enrollment or application may provide better insight into each employee’s overall engagement and their aptitude for growth. Plus, one organization who made their education-backed career ladder completely voluntary still saw 90% of its patient access employees participate.
- Balance the Levels: Per the experience of HBI’s Custom Services Team, who is out in the field advising revenue cycle leaders, some organizations seek to have 10-15% of its representatives at level one, 70-75% in mid-level positions, and 12-20% in more senior roles. Additionally, the ideal ratio of managers and/or supervisors to front-line staff is 1:8 based on HBI’s recommendations, though 1:13 may be more a realistic goal, as most organizations see a 1:20 or even 1:30 ratio.
The combination of “dos” mentioned above have led real-world results of a more highly-educated, certified, and skilled workforce. A career ladder also better allocates resources to those staff members who are investing more into their role and career at the organization, unlike across-the-board annual merit hikes. Employees, in return, feel invested in and therefore motivated, enthusiastic about work, and more productive. This mutual relationship eventually boosts organization’s overall performance, revenue, and customer service.