Hospitals struggle to find good revenue cycle candidates as demand rises

With revenue cycle staff in big demand, healthcare providers are scrambling to find candidates with this specialized type of experience before initiatives like ICD-10 and value-based payments put too much pressure on cash flow.

With revenue cycle staff in big demand, healthcare providers are scrambling to find candidates with this specialized type of experience before initiatives like ICD-10 and value-based payments put too much pressure on cash flow.

"Absolutely there is a shortage," said Ann Trotter, a healthcare finance recruiter with Kaye/Bassman International Corp. "It doesn't look like ICD-10 will be delayed, so it is putting hospitals in hyperdrive because they know their dollars are going to plummet."

For example, Trotter said she recently spoke with a revenue cycle pro who who was considering moving from a 300-bed hospital to working at a much smaller critical access hospital that would pay her the same to work for the smaller facility. According to the candidate, pay rates for revenue cycle pros is much higher than she found a few years ago.

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Trotter said most in the industry say recruiting revenue cycle pros has become increasingly challenging as industry changes means desired skill sets have changed as well.

Trotter said she sees the focus moving from hospitals seeking people with experience working all aspects of revenue cycle to finding candidates that have had success specifically with collections. This is occurring particularly with critical access and smaller hospitals, a sector of the industry that has been squeezed by lower profit margins.

"Revenue cycle candidates have to be able to show that they have improved processes and have brought in more dollars," she said. "That they have really made a difference in their departments."

People with experience at larger hospitals are also hard to find, Trotter said, a situation that isn't being helped by smaller hospitals willing to pay more money to get skilled professionals.

Recruiting is a challenge because an adequate candidate just won't do the job in revenue cycle. Trotter said she is not only recruiting for new positions, but for replacement at hospitals where revenue directors are no longer meeting expectations.

Margaret Schuler, executive director of revenue cycle for OhioHealth, said she has struggled to find people that are not only good with processes and technology, but with softer skills as well.

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"We have to find people that are self-motivated, curious and not concerned with taking risk," she said. "People that are going to lean in and have high emotional intelligence."

Mick Ruel, vice president of executive search at B.E. Smith, agreed that it is the soft skills that are crucial for candidates. What people have on paper isn't nearly as important as what he sees in an interview. Organizations he works with are looking for candidates that focus on overall revenue cycle understanding rather than on its individual parts, he said.

"The overall collaboration from front to back is the differentiator and it can be identified through the interview process," he said. 

Schuler said revenue cycle isn't a simple debit and credits job and every day is new and challenging. Not everyone enjoys being in an environment where they are dealing frequently with crisis management.

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Because of the requirements of the job and the importance of a good cultural fit, she has had better success growing people internally than recruiting from elsewhere. That said, there are about 1,500 people in revenue cycle positions and only a handful of leaders that are going to continue up the ladder, she said.

With the challenges in the industry and a shortage of great candidates, Ruel said they may have to send in temporary help, but eventually they are getting positions filled. And not all organizations are having difficulty.

Vicki Di Tomaso, national president of the American Association of Healthcare Administrative Management, said in an email that she has not had problems finding qualified candidates for positions at Lee Memorial Health System in Fort Myers, Florida. where she works as system director for their central business office.

She said turnover is very low at her organization and at other hospitals she queried nationwide.

"While the complexity of healthcare is certainly increasing every year, common sense and basic tenets of what we do, fortunately, still rules the day," she said.

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