What qualities should you look for in revenue cycle management staff?

1 Knowledge and experience

RCM staff should have a solid understanding of the health care industry, including the policies, procedures, and regulations that govern it. They should also have relevant experience in the specific areas of RCM they are assigned to, such as coding, billing, claims, denials, or collections. Additionally, they should be familiar with the software and systems that support RCM, such as electronic health records (EHR), practice management (PM), and clearinghouse platforms. You can assess the knowledge and experience of RCM staff by reviewing their resumes, conducting interviews, and verifying their credentials and references.

3 Accuracy and attention to detail

RCM staff should have a high level of accuracy and attention to detail, as they deal with sensitive and complex data that can have significant financial and legal implications. They should be able to follow the established protocols and standards for RCM, such as coding guidelines, billing rules, and compliance regulations. They should also be able to identify and resolve any errors, discrepancies, or issues that may arise in the RCM process, such as incorrect codes, missing information, or denied claims. You can measure the accuracy and attention to detail of RCM staff by administering tests, checking their work quality, and tracking their performance metrics.

4 Problem-solving and critical thinking

RCM staff should have good problem-solving and critical thinking skills, as they face various challenges and obstacles in the RCM process, such as changing payer requirements, complex cases, or patient disputes. They should be able to analyze the situation, gather relevant information, and apply logical reasoning to find the best solution. They should also be able to anticipate potential problems, prevent them from escalating, and mitigate their impact. You can test the problem-solving and critical thinking skills of RCM staff by presenting them with scenarios, asking them to explain their reasoning, and reviewing their outcomes.

5 Adaptability and flexibility

RCM staff should have a high degree of adaptability and flexibility, as they need to cope with the dynamic and evolving nature of the health care industry. They should be able to adjust to new technologies, processes, and regulations that affect RCM, such as EHR updates, value-based care models, or telehealth services. They should also be able to handle multiple tasks, priorities, and deadlines, and switch between them as needed. You can assess the adaptability and flexibility of RCM staff by asking them about their experience, giving them feedback, and exposing them to different situations.

6 Motivation and initiative

RCM staff should have a strong motivation and initiative, as they play a key role in the success and sustainability of the medical practice. They should be driven by the goals and values of the practice, and committed to delivering high-quality RCM services. They should also be proactive in seeking opportunities to learn, improve, and innovate, and willing to take on new challenges and responsibilities. You can gauge the motivation and initiative of RCM staff by asking them about their achievements, aspirations, and interests, and recognizing and rewarding their efforts and contributions.

7 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?