#197 The $40,000 Hire With the Perfect Resume

👉 Free RECOVER Diagnostic: eligibility.natrevmd.com/recover-diagnostic 

The exact framework we use when we walk into a new practice. Takes five minutes. Results are immediate. 

Missed Part 1? EP196: https://podcasts.apple.com/us/podcast/196-%24112-000-buried-by-a-billing-manager-who-was/id1624182351?i=1000777197553

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A billing manager with seven years of experience and a certified coding credential took a job at an independent practice doing $300,000 a month. Six months later she was gone. The practice was $40,000 short. Not because she lacked skills. Because the moment she hit a problem she had not seen before, she buried it for three months rather than admit she did not know what she was doing. 

The credentials were real. The mindset was wrong. 

This is the close of the two-episode arc we opened in EP196. Part 1 was about the culture cost: culture is a revenue decision. Part 2 tells you which decision. The mindset you hire is the culture you build. 

What Microsoft Actually Proves.  In 2014, Satya Nadella inherited 220,000 people operating under stack ranking, a performance system that rewarded knowing things and punished not knowing. The result was a workforce where the safest strategy was ensuring someone else failed before you did. Nadella named the framework he wanted to replace it with in four words: from know-it-all to learn-it-all. He did not fire 220,000 people. He changed what he selected for, what he rewarded, and what he modeled. 

Hiring for Mindset Over Credentials.  Skills can be developed in six months. Mindset takes years. Three interview questions do most of the work: tell me about a time you were wrong at work; what have you learned in the last six months that changed how you do your job; walk me through a denial pattern you found that the practice had not noticed yet. 

High Performance vs High Potential.  These are not the same thing. A high performer executes the current job excellently. A high-potential employee also demonstrates the capacity for significantly more complex responsibility in the future. Four signals: learning agility, emotional intelligence, proactive problem-solving, influence without authority. The HiPo you do not recognize and develop will leave, and it will look like a resignation instead of the talent management failure it actually is. 

Graduating Responsibilities.  As individuals develop, their role in the practice must change with it. The billing coordinator builds mastery. The senior coordinator builds ownership. The billing manager builds strategy. The graduation must be structured explicitly, or the promoted employee does two jobs for one salary and burns out. 

Role Level Focus Reference 

Billing Coordinator 

Primary focus: Queue execution, denial processing, eligibility verification

Stop doing as they advance: Nothing yet, this is the mastery phase 

Senior Coordinator / Lead 

Primary focus: Process ownership, protocol updates, training new staff 

Stop doing: Working claims the coordinator can handle 

Billing Manager 

Primary focus: Denial trend analysis, weekly reviews, reporting to leadership 

Stop doing: Queue work, individual claim decisions 

Director of Operations 

Primary focus: Revenue cycle strategy, vendor oversight, cross-site performance 

Stop doing: Managing individual billing staff daily tasks 

Three Actions This Week 

• Change one interview question. Replace one credential-verification question with: tell me about a time you were wrong at work and how you found out. 

• Name your one high-potential employee. Schedule 15 minutes with her this week and ask: what part of your work do you find yourself most drawn to. 

• Map one responsibility graduation. Identify one task a higher-level person is doing that a lower-level person should be. Write down the task, the person, and the transition date. 

Episode breakdown 

00:00 — The $40,000 hire with the perfect resume 

02:30 — What Microsoft actually proved 

06:00 — The four-word framework 

09:15 — Hiring for mindset over credentials 

13:40 — The three interview questions 

17:00 — High performance vs high potential 

21:00 — The four signals of high potential 

25:00 — Graduating responsibilities 

28:00 — Three actions this week 

30:00 — Free resource + close 

👉 RECOVER Diagnostic (free, 5 minutes) 

eligibility.natrevmd.com/recover-diagnostic 

Website: natrevmd.com 

Trusted Resources: natrevmd.com/trusted-resources/ 

Referenced in episode: 

Hit Refresh by Satya Nadella 

Mindset: The New Psychology of Success by Carol Dweck 

Transcript

SPEAKER_00 0:04

Last week we talked all about different ways that culture impacts your revenue and how different management styles impact your bottom line. Today we're going to talk about the three questions you can ask your team when you're hiring someone to make sure they fit into the culture that you are building within your practice. Welcome to Nat RevMD, a podcast where we share tips on optimizing medical billing and improving practice efficiency so you can have the business of your dreams. I'm your host, Dr. Heather Signorelli, founder of Nat RevMD. Let's get started. So today I want to talk about what we've even experienced when it comes to hiring. So as you guys know, I live in two different worlds. I have been part of a large healthcare company. We deal with hiring decisions all the time. And then we have our RCM company, obviously, where we hire and train and build a team that helps support art the practices that we work with. And um, we've all been there. We've all made hiring mistakes. And I think one of the things that I really struggled with in the beginning of hiring is that I really relied on the credentials, on the resume around what do the are what are they credentialed with? What is their degree? What roles have they held within different practices? I do always look at the the frequency of job changes, which I do think is still important. But I think in the past, I've really relied too heavily on just what their resume shows in terms of their credentials or what their certifications are in, again, what role they've had versus what am I actually asking this person to do and what is what is the culture that I want them to bring to the to the company so that then we are aligned in what good looks like. And so today we're gonna talk about really how you frame understanding the culture that you're wanting to build in a practice, and then how that is implemented when it comes to hiring folks. And we're gonna give you guys three questions that we've used and a process and a framework that we've used for hiring folks. I will say that we've been very lucky. I have not had anybody from our leadership team leave our company, which I am very proud. We have some incredible team members on our team. We've had to let go of people in the past when expectations and and needs weren't met. And I think there's that saying, you know, hire, hire fast, fire, or no, there's that saying, hire slow, fire fast. And I do believe that that is something that you can uh you can implement. I also really like a lot of the Alex hormosey and Layla hormose when it comes to hiring. I think Layla does a lot of discussions on that that we've listened to and we've used and implemented. Um, so if you haven't heard those two in terms of podcasts, I highly suggest wrecking them out, recommending them. All right, so let's talk about a time where we actually hired somebody that looked perfect on paper, right? So we have all been there where they look perfect on paper. They know the content, they know the terminology, they know the billing landscape for us. It's billing landscape, you may be hiring an office manager, but they knew the right questions. They even knew how to implement it and were very detail-oriented. They knew denial management very, very well, but they did not embody the culture around working as a team that really drove a wedge within our own leadership team. And again, this wasn't because they lacked skills. It's just because they didn't have the ability to work as a team that we needed in order to drive the results for our practices. And so obviously, we've all been there where we hire the wrong person, not because of the credentials, right? They knew how to do the job, but they didn't know how to do it in the right mechanism or with the right results or with the right attitude or ability to drive a team atmosphere that allows your entire team to be better. And I think, you know, for a lot of you guys with practices, right, you're hiring people that need to work within a team. Same with us, right? We're all we're we we have multiple teams. So it's almost like a matrix organization when we work with people because we have our billing teams that we help support. We have our own internal leadership team dynamics, and then we have the client dynamics. And so when we hire somebody on our own team, they have to be able to not just do the job, not be able to audit the charts, not be able to just manage the metrics, but they have to be able to inspire and embody this desire for every single one of those areas to want to be better, right? So they have to work with the client and the front desk staff and training them on how to do eligibility checks. They have to be able to technically know the subject, but working in a team atmosphere in those three different areas involves having somebody who truly can motivate and inspire and make people feel like they're doing a good job when they are, but help coach them and mentor them to do a better job when that needs to happen as well. And so we've made that mistake before. And so what we're talking about today and how to frame your evaluation of new hires can be applied within the practice setting. And so when I think about hiring, you know, that middle level or even higher level manager within your practice, you want them to be able to mentor and coach team members for them to be able to monitor metrics and improve them and drive them to success, but then also be able to identify challenges and barriers and then rally the team around them to be able to identify what is the root cause of, you know, a metric going out of order or team members not showing up for work timely or not doing the tasks that they're given. How do we rally that team to understand what good looks like and then how to execute and then managing those people who aren't executing appropriately, right? Because that's what we're looking for in terms of a leadership structure. And I know that sometimes that's hard when you're new and maybe you don't have the funds for that higher level manager. So I think having the skills to identify individuals who maybe don't have every perfect credential, but do have that right culture or value when it comes to growing with the practice over time so that you can elevate them over time, give them the raises over time so your revenue has a chance to catch up, but they have a chance to grow as well. And, you know, I was listening to another podcast, actually Ray Dalio, which is an in you know, an investor. He was on the podcast My First Million. And I really liked what he talked about, which I think ties into this whole topic, right? He talks about how there is three different ways that you can hire people. You can hire them for skill sets, you can hire them for values, and you can hire them for ability. And that a lot of people put a lot of emphasis on skill set, right? Do they have the skills to do the job? And that becomes the highest ranking thing when you go to hire somebody is it's all, do they have the skills? Do they have the skills? Which is the, you know, they're really focused on the credentials, right? So do they have the credentials, right? Have they done this job before? Do they have the degree? Do they have a certification? But they forget or they they don't address or evaluate things around values and things around ability. And so because you've put so much emphasis on credentials, that then you forget to evaluate values within an interview. And so he really suggests the opposite, right? That we really focus on the values that a that a person has and that the values that a person have can lead them to having a stronger, a stronger ability to do things and that you can always get them the credentials that they need. And to some degree, I think that obviously somebody can't come in cold. They know nothing about, you know, healthcare and medical practice, right? They've got to have some sort of background within healthcare to make sense for depending on the role that you're hiring. But I but I think it's a the point is that we don't want to just hire or just evaluate in an interview session the credentials of somebody, right? And so we really want to hire somebody who has the values that we need that go along with the skill sets, but that we can help teach them the ability or the additional credentials if they have the right values at hand to be able to manage a position within our practice. You know, back to the employee that we had hired, that individual wasn't the right fit for us. While they technically had the right skills, they knew RCM, they weren't able to motivate and manage the relationships in the different areas that we needed. And it wasn't the right fit. And so I think even with the best of credentials, if they don't have the right values that work within your team dynamics, those hires can be detrimental to your practice. So today we're talking about hire, how to hire that right person so that you don't have that situation happen to you. So on paper, you can have the person with the right years of experience. They could be even a certified practice manager. Maybe they've worked in those roles multiple times. Maybe they have um, you know, great long-term success at certain practices. But if they just know the terminology and the technical skills, but they don't know how to manage within a team dynamic where you're trying to grow a practice, it's gonna fall flat regardless of the years of experience that they've had. All right. So first let's talk about Microsoft's trans transformation. I think last week I talked a little bit about the book 10 to 25. Again, that's a parenting book, somewhat unrelated, although it does closely correlate with us hiring and managing the right people, just because, you know, a lot of that philosophy around managing yet young adults actually applies to managing team members. So it's a really good book. But in the book, they talk about Microsoft's transformation. So last time I briefly touched on the Microsoft culture that they previously had, which they actually had this system within Microsoft where they ranked their employees or they had their managers rank their employees from top to finish. So somebody was always at the bottom, right? Regardless if you had 10 employees where all 10 were amazing, somebody had to be at the bottom. And this was a culture that they had for almost 10 years. It's uh was called stack ranking. And obviously, when you have that sort of setup, people are going to inherently want to keep knowledge close to the chest. They're going to want to look better than their peers. They're going to want to stifle innovation. And so in 2014, they actually hired a new CEO and he walked in and had this massive team, you know, 200 plus thousand people who were operating under this, you know, fairly antiquated or in my opinion, terrible performance management system, right? Where they're all, they're all meant to, to, you know, rank their employees, regardless of actually if some or all of them are actually doing really well. And so, you know, he walks in there and he's got a team of people who aren't collaborating. They are uh not problem solving together, right? And so he, that was a situation where you could have the most talented people on earth, but if they're not collaborating or working together, you're never going to get the performance that you need with that sort of setup, right? So the new CEO's insight was that the problem was not the people, right? It was the system that had been produced. And so he had the job of taking this know-it-all culture and pushing them into a culture of learn it all. And that was the framework that really turned Microsoft around. And he actually has a book. It's called Refresh or Hit Refresh. And he really talks about in that book how to get your team into a learn-it-all culture. And I think that this is such a beneficial place for us to learn lessons about how we seek out and hire the right individuals that will be that will focus on that learn it all culture, right? Because in that setting, you don't always believe that you are right. You believe that in every scenario, you have something to learn from your teammates, from your clients, from each other that allows you to walk into a scenario and go, okay, here's a problem I'm trying to face and solve. How do I take that problem and solve that with my team members, with my colleagues? And obviously, when you're in a leadership role, you have to, you know, be able to lead people to be able to do that. But in his book, he actually goes through the framework where they evaluate why people, some people continue to scale their abilities where other people completely plateau and actually can harm the team culture. And so the the belief is really coming down to the individual's values, which is what we're talking about today, right? So it's not just about the credentials, but it's really based on the values that somebody has walking into a new job. And that's really about this ability to always be able to learn, both from your peers as well as, you know, superiors, as well as external individuals as well as internally, that you're always able to be able to learn how to do better every single day. And they believe the team can do better. They believe that they can work with their, you know, patients, you know, in a patient setting that they can do better. And that in the right conditions, being able to hire people with those values allows you to select the people that are going to be able to take your practice to the next level. So what this means in practice is that, say, you're hiring that practice manager or even a COO, and maybe they have, you know, 10, 15, 20 plus years being in that role. So technically, right, they look like the right, right person. But if they have this inability to work with others, to be able to mentor and coach and lead and delegate, then they are going to struggle in the role. And maybe technically they can do the job, but from a culture perspective, it's going to ruin what you're building in the practice. And so next, we're going to go over again those three questions that you can ask within an interview setting so that you, just like the CEO, the new CEO at Microsoft did in 2014, you are applying strategies to identify the people who have the right values, who will then build the right abilities. And obviously, still also, you know, you know, recognizing that credentials or having the right credentials is important, but it's not the most important thing within your practice. All right. So now we're going to talk about those three questions that you can ask in an interview in order to understand do they have the right values that you need? All right. So question one that we have used to hire the right folks within our own team. So the question is tell me about a time when you were wrong about something at work and how you found out. And so, really, what you're trying to identify here is does somebody have an ability to identify a time that they were wrong, right? Humility, really important. And so somebody who struggles with a question like this or being able to describe an external circumstance that caused an error, error or even something that they did wrong, is going to show you whether or not they're going to be able to do that in practice. We all make mistakes. We all have issues where we do something wrong. And so you want to be able to identify candidates that have the values that they can be wrong, how they addressed that, how they moved on or what they learned from that, right? Because then we're back to we we're setting a culture around we're learning because the know it all versus the learn it all premise is really, really critical in any sort of company setting, especially medical practice, where we know it's ever changing. There's, you know, evolving technology, there's evolving clinical needs, there's evolving payer, you know, situations. And so at every point in time, there's always going to be something to learn. And so this is a question that you can hear about their willingness to be wrong and how they handled that. And you can tell in their response, you know, one, if they say, okay, gosh, I've never been wrong, okay, that's a red flag. But then how do they frame being wrong? Are they blaming it on somebody else and always blaming it on, you know, external circumstances, or are they able to recognize, like, hey, I actually did this incorrect and I learned from it. And here's how we moved on from that. So, really, really good question to ask. And number two is what is something that you've learned in the past six months that changed how you do your job? And so obviously a candidate who cannot answer this is not actively learning, right? They're not actively being able to understand that things sometimes change and we're all learning, right? Myself included, and I'm sure everybody who's listening to this. And so you want a candidate who answers with a specific skill, right? Maybe they had a pair rule that changed or a denial pattern that they had to implement, or, you know, front desk uh workflows that needed to be updated. And they were able to identify that and then learn that new information and then be able to successfully roll it out again within a team setting. Again, I'm I'm kind of taking this with the premise of hiring a management level individual. So you want somebody who has the ability to learn something new and then implement that or share that with the team. And then question three is then actually having them walk you through a pattern or an issue that they found that maybe they were the first person to discover it. And then how they use that information to get more information from their team members and then identify a workflow fix and then roll that out within the team. And you're you're working with them to understand a true concrete example that allows them to show a skill set of being able to identify a problem, identify a solution, and then use team members to solve that problem. And this allows them to show skill set, right? So do they have the skill set to understand, you know, the problem at hand? And you can even be more specific. And if you have specific problems within your practice going on right now, give them that example of have you seen this problem and solved for this problem in, you know, one of the practices that you've managed. But giving them something specific, a task, but then understanding, okay, how did they solve for that? And then how did they get and rally their team around that solution? You could even do a follow-up question where you're asking them, okay, tell me about a time where that was not a popular solution, but you knew it was the right thing. How did you get your team members rallied around something that was not inherently popular? And so these, again, allow you to see how they think, allow you to see how they lead, allow you to see how they encourage, you know, somebody moving in a direction that maybe they didn't want to go in, which as leaders, we always have that scenario. And so skills can be developed, right? Skills can be something that you can develop somebody, especially if you have that knowledge yourself. But values inherently take years to change, I believe. Again, this is just my own, you know, opinion on this. And so if you if you identify candidates that have the right values to wanting to learn, to wanting to lead people, to understanding that everybody has a point of view and that that person needs to be able to listen to other people's point of views as you try and solve complex issues, especially in a management position. You want to hire the candidate with the right values. Obviously, they have to have adequate skills, they have to have adequate credentials, right? But not just focusing on those credential skill set heavy candidates that then you've not even evaluated their values. And so if they're lacking those values, regardless of the skills that they have, they may struggle in your practice, especially if you have a small team. And so, really, really focusing again, flipping that narrative of I'm gonna focus on values and I'm gonna interview based on values. And then obviously they have to have a minimum level of skill set and and credentials, but that's not gonna be the only thing I focus on. So, again, the other thing I'll I'll touch on today is really identifying those high potential employees that are already in your practice, especially for those medium, large size practices, where you've got those really good individuals who are ready for that next leap. Maybe they don't have that skill yet today, but they have the values, they have the ability. So then how do we move them into those roles? And so it is a common and and maybe even expensive mistake where you treat those high performance individuals and those and high potential as the same thing, right? Because high performance and high potential may be different. And the difference between that really is going to be how you decide who you invest your resources in. So a high performer executes the current job effectively, right? So they they show up every single day, they hit their metrics, they do what they're asked, they check off the checklist and they they do it well, right? They're maybe a joy to be around, they're a valuable asset to the team, but they may not be necessarily somebody who who should the who should be the next practice manager right when the when a current manager leaves, right? They may not have the right ability to do that next level job. Now, high potential employee does all of the things that the prior example did, right? They check the checklist, they do, they do all of the tasks of their job, but they do something additional, right? They have the capacity to take on more. They're actively learning and seeking out problems within the practice to then offer support and ability to fix those problems. They're going and searching for the responses. They're going and searching on the, you know, maybe the chat boards to see how other people have resolved this. They're calling the EMR vendor, going, hey, we've got this issue. How do we, how do I fix that? Right. So they're not just doing their job well, right? That's the, that's the minimum, right? But they're saying, okay, how can I be more valuable in in the practice? How can I do more without being asked? And those are the individuals, that's the high performance high potential employees that you want to seek out for management and not just the high performers, right? Those, again, those high performers are, I'm doing my job, I'm doing it well. The high potential employees are those people who are doing my job and doing it well. But now I'm doing all of this extra stuff that I wasn't even asked to do. And again, this comes down to values, right? Because they're willing to push and do more without even being asked. And those are the individuals, those high potential individuals are the ones where you can evaluate is there a role for them? How do I give them career advancement? How do I make them a lead of the front desk or, you know, a manager or an assistant manager to be able to have a retirement plan or succession plan for that. you know, true office manager that's there who's maybe, you know, two, three years from retirement. And so the other thing that these high potential individuals do is they often are the ones that are influencing their peers, right? Maybe they don't even have formal authority, but they're influencing how others do their job. And so those are the individuals that you want to seek out. So a couple things that can signal for you that whether those candidates that you are interviewing or those individuals that are already on your team could be high potential is that they're, they're, that all they want to do is learn, right? They're they're wanting new information, they're want new workflows to help improve efficiency and they're figuring that out oftentimes without being asked. Number two is that they have the emotional intelligence, right? So they know how to read a room. They know when a physician or somebody in the practice is stressed and they adjust how they communicate based on that room environment. They can handle conflict with different team members without always having to escalate it to leadership. And those things they can do without venting negatively within the team to bring down that team culture. Number three is that they are oftentimes proactive when it comes to problem solving, right? They're not being, they're not waiting to be told what to do. They're just doing it. They're fixing the denial patterns, they're addressing the issues without even being asked, but in a collaborative way that doesn't make it seem like they're already in the boss's seat, right? And then last is that they have an ability to influence without always having just this authority. That could be a front desk coordinator who maybe not doesn't have a formal authority over the front desk, but she's rallying the team to fix eligibility workflow issues or she's rallying the team to create scripts to collect patient dollars, you know, collect patient AR better. Right. So these are kind of the two kind of frameworks that we use to help, you know, assign the right people within our own team. So again, those hiring questions to identify people with the right values and then also how to evaluate internally your team to see if there's somebody who they are already that may be ready. And again, the goal here is really understanding what do I need and how do I hire the right person for those for those roles. And then last, obviously using those individuals who are those you know high potential folks to give them graduated responsibility and a career ladder is going to be something that is always going to be able to help support not only, you know, the end results of the of the practice, but also the culture within your team. All right. So three actions this week first, evaluate your interview questions, change one or add one of the questions that I provided and really think about the values that you want for the role that you're hiring. Number two is really evaluate your current team members, identify those high potential employees, either if you know you know who they are or working with your office manager to know who they are so that you can start thinking through okay, how do we give this person graduated responsibilities? How do we identify things that we can praise them for to again encourage that problem solving of things outside of their role and then plan for those career advancements and succession planning internally within your team so that you're already prepared for the next step. And then last is map, map those graduated responsibilities that you can give those individuals, those high potential individuals, so that A, you're getting additional help within your team that is necessary, but you're also testing that person's and ability to be able to take on those graduated responsibilities and have that conversation with them. Hey, we're going to be giving you some graduated responsibilities and really this is because we've identified you as high potential. We want you to grow with the company we want to hear your, you know, desires to grow with the company and how we can map that out together. All right. So last thing to share is that we do have a recover diagnostic down in the show notes. So it's a link and it is a great way for you just to assess how things are going within your practice today and areas of opportunity that you can address. So hopefully this helps as you guys hire the right people and get the right folks into your own company. I know this has been very helpful for me in different stages in my in my career and thought I would share these notes. All right thanks so much. We'll talk to you soon to be a little bit more than a little bit of