Diving into what attributes are needed for success
by Gautam Char
Revenue cycle management (RCM) is an essential function for maintaining the fiscal stability of healthcare organizations. The revenue cycle leader ensures that their organization is paid appropriately for the care provided.
RCM leaders need to have impeccable knowledge of the revenue cycle and the many workstreams within their department in addition to those in other organizations that affect it. They need to have masterful interpersonal management skills to establish and maintain relationships with payer, clinical, and other leaders as well as adept management of their own team. Finally, they must understand technology and how it can be deployed to ensure predictability of the revenue cycle. Let’s take a deeper dive into the various attributes needed for success within this essential role.
RCM leaders spend a significant amount of time running the central business office (CBO) and ensuring rigor is applied to billing functions. The CBO possesses and manages several different capabilities including patient access, charge entry, posting, and denials management. This team also collaborates closely with health information management to ensure timely coding of encounters and for procurement of documentation that payers require to supports claims.
Due to the complexity of revenue cycle workstreams, the CBO also requires experienced staffing capabilities. It can take years to come up to speed with the complex workstreams, government guidelines and payer nuances, not to mention constant updates to technology, policies and more. And it is the RCM leader who is responsible for onboarding new staff, retaining existing staff, selecting outsourcing partners and ensuring that everybody is proficient and compliant despite constant changes impacting the revenue cycle.
The RCM leader must also be able to perform a variety of duties to efficiently manage the entire ecosystem of operations and optimize revenue for the organization. Examples include:
While technical skills are absolute critical to keeping revenue predictable for any organization, softer skills are equally important. Good people managers need to balance fairness with empathy. They must demonstrate competency without arrogance. They must be able to adapt their communication skills to the situation to create an environment where optimal outcomes can occur. This includes administering organizational policy while remaining mindful of the confines of federal and state laws as well as ethical boundaries.
Revenue cycle leaders play an integral role within their department and across the healthcare enterprise. They must build and maintain relations with individuals at all organizational levels including:
Patient and Customer Relations
With increased consumerism in healthcare and more patient financial responsibility than ever, it is important that RCM leaders understand these market dynamics. Since patient financial responsibility can be 25% of payments, RCM leaders need to devise strategies to maximize cash flow opportunities. For example, payment plans, clear and understandable bills and financing options can help patients and their families with expensive care plans afford care.
Even with the best laid plans, sometimes things go wrong. And when they do, RCM leaders must be able to handle and resolve a wide range of issues related to the customer service experience.
Payer Relationships
Interpersonal communication and people management skills extend far beyond the CBO. While RCM leaders must establish themselves across their organization and be responsive to queries, problem solving and strategic planning needs, they must also establish and cultivate relationships with payers. Any time a payment or contract issue crops up, it’s much easier to call on a friendly contact at a payer organization rather than a stranger.
Professional Network
Networking with other RCM colleagues in the market, the state, region and even nationally offers opportunities to compare notes and learn. Networks can be great sources of inspiration, suggestions for how to handle unusual or difficult issues and even sharing benchmarking data. By establishing these high value relationships, you create a tribe of mentors and supporters for career and professional growth.
Vendor Relationships
Vendor relationships are also important. Successful RCM leaders regularly surveille the market for ideas that can further simplify and expedite cash collections and identify opportunities to enhance revenue. A deep analytics vendor, for example, can change the game on how RCM is run. While vendors are in business to sell their product or service, their companies build innovative tools to solve some of the most fundamental and vexing revenue cycle problems. When tapped, your vendors can become an important source of inspiration. They will often share market trending information, best practices, tips and tricks, case studies and more. They want you to be successful as their future depends on it.
The success of a revenue cycle leader is greatly dependent upon possessing a fine-tuned sense of resourcefulness and people skills. RCM leaders must drive performance of their teams and influence a number of other individuals outside of their organization. To become a successful revenue cycle leader, individuals must develop the comprehensive skillset to excel within their role.
About Gautam Char
Gautam Char is the president and CEO of WhiteSpace Health. He has a wealth of experience bringing products to market and rapidly growing companies. Known for building high performance teams that create valuable products and solutions for customers, Char’s talent for collaboration and his industry knowledge will position WhiteSpace Health for growth and excellence. Contact: Gautam.char@whitespacehealth.com.
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