Most healthcare organizations have an employee everyone turns to when they don't know what to do.
Maybe it's the biller who knows how to resolve the difficult claims, the credentialing specialist who understands a particular payer, or the employee who knows which portal to use, who to call, and how to handle the unusual situations that aren't covered in a procedure manual.
Having experienced employees with this level of knowledge is valuable. However, when important revenue cycle knowledge lives primarily with one person, it can create an operational risk that leadership may not recognize until that employee is unavailable.
A vacation can expose it. So can an unexpected absence, resignation, or retirement. Would the work continue without them?
How Does One Employee Become the Expert on Everything?
Usually, it happens gradually. An experienced employee becomes particularly good at handling certain tasks, so coworkers begin bringing questions to that person. Over time, more responsibilities naturally migrate in their direction.
Eventually, one person may understand how to work a difficult payer, handle complicated credentialing issues, resolve unusual claim problems, or run reports that no one else knows how to produce.
As long as that employee is available, the process may appear to work well. Leadership may not realize how dependent the organization has become on one person's knowledge.
What Happens When That Person Isn't Available?
Consider what would happen if your most experienced billing employee were unexpectedly out for several weeks. Could someone else work the outstanding claims they normally handle? Would another employee understand the status of pending appeals, know how to access the necessary payer portals, find the reports used to monitor A/R, and follow up on unresolved payer issues?
Apply the same questions to credentialing, coding, prior authorizations, eligibility verification, payment posting, and other important revenue cycle functions.
If important work has to wait for a particular employee to return, the organization may have a single point of dependency. That dependency can eventually affect reimbursement, productivity, and the workload of other employees.
Valuable Employees Shouldn't Be the Only Source of Information
Experienced employees should have specialized knowledge. Their expertise strengthens the organization, especially when that knowledge can be shared with others. The concern is what happens when important information hasn't been documented or transferred.
For example, one employee may be the only person who knows how to run a particular report or resolve a recurring payer issue. Another may be the only person tracking an important credentialing deadline. If that employee suddenly becomes unavailable, someone else may have to reconstruct the process while the work waits.
Cross-training and documentation help preserve the knowledge your experienced employees have already developed.
Don't Forget the Workarounds
Formal policies and procedures only tell part of the story. Experienced employees often know small details that aren't included in a procedure manual. They may know that a particular payer requires an additional step before certain claims will process correctly, who to contact when an enrollment issue gets stuck, or how to identify a payment that hasn't posted as expected. These workarounds can become part of the normal workflow even though they were never formally documented.
Ask employees about the exceptions they regularly handle, the problems coworkers routinely bring to them, and the steps they take to resolve those issues. Those conversations may uncover important processes leadership didn't realize depended on one person.
Access Can Become a Problem Too
Knowledge isn't the only thing that can become concentrated with one employee. Access to the tools needed to do the work can create similar problems. Payer portals, clearinghouses, reporting systems, credentialing platforms, and other revenue cycle tools may depend on individual accounts and permissions.
Leadership should know who has access to important systems and whether appropriate backup access exists. An organization doesn't want to discover during an employee's unexpected absence that no one else can access a payer portal, retrieve a report, or complete a time-sensitive task.
Cross-Training Doesn't Mean Everyone Needs to Know Everything
Cross-training should focus on the responsibilities that could create the greatest disruption if the primary employee became unavailable.
For those responsibilities, determine whether you have:
- A documented process
- An identified backup
- Appropriate system access
- Cross-training on essential tasks
- A way to identify outstanding work
- Clear tracking of important deadlines and follow-up
The goal is to make sure essential work can continue when someone is unavailable.
Ask Your Employees This Question
One question can help leadership uncover where these dependencies exist:
“If you couldn't come to work tomorrow, what would no one else know how to do?”
Ask employees to think beyond their formal job descriptions. What information exists only in their heads? What problems always get sent to them? What deadlines are they personally tracking? Which systems can only they access? What processes would coworkers struggle to complete without their help?
The answers may reveal vulnerabilities that aren't visible on an A/R report or revenue cycle dashboard. They may also identify opportunities to document processes and transfer valuable knowledge while the person who understands them is still there to help.
Protect the Knowledge Your Team Has Built
Experienced employees can accumulate years of knowledge about your practice, payers, systems, and processes. Preserving that knowledge should be part of protecting your revenue cycle.
Identify where important responsibilities depend too heavily on one person. Document essential processes, establish appropriate backup access, and cross-train employees where an absence could disrupt reimbursement or operations.
The goal is continuity. When an employee takes a vacation, changes roles, retires, or unexpectedly leaves the organization, essential revenue cycle work should still be able to move forward.
Frequently Asked Questions
What is a single point of dependency in the revenue cycle?
Which revenue cycle functions should have backup coverage?
How can we identify knowledge that hasn't been documented?
Does cross-training mean everyone needs to know every job?
Would Your Revenue Cycle Keep Moving?
You may already know which employees hold the most institutional knowledge in your organization. The next step is understanding what would happen if one of them were unexpectedly unavailable.
Applied Medical Systems helps healthcare organizations evaluate the people and processes supporting their revenue cycle. Through Practice Administration Coaching, medical billing, coding, credentialing, and revenue cycle assessments, AMS can help identify operational gaps and strengthen processes that may be overly dependent on one person.
Ask your team the question now, before an unexpected absence answers it for you: If you couldn't come to work tomorrow, what would no one else know how to do?
