PROFESSIONALISM (HEALTH INSURANCE)

The Merriam-Webster Dictionary defines professionalism as the conduct or qualities
that characterize a professional person. Developing workplace professionalism
is the result of individual work on the following skills:
Attitude and Self-esteem
“For success, attitude is equally as important as ability.”
Harry F. Banks


Attitude impacts an individual’s capacity to effectively perform job functions,
and an employee’s attitude is perceived as positive, negative, or neutral. This
subconscious transfer of feelings results in colleagues determining whether
someone has a positive attitude about their work. Self-esteem impacts attitude:
low self-esteem causes lack of confidence, and higher self-esteem leads to selfconfidence,
improved relationships, self-respect, and a successful career.

Communication
“And he goes through life, his mouth open, and his mind closed.”
William Shakespeare
Successful interpersonal communication includes self-expression and
active listening to develop understanding about what others are saying. To
listen effectively, be sure to understand the message instead of just hearing
words. This active involvement in the communication process helps avoid
miscommunication.

Conflict Management
“When angry, count to ten before you speak; if very angry, a hundred.”
Thomas Jefferson
Conflict occurs as a part of the decision-making process, and the way it is
handled makes it positive or negative. People often have different perspectives
about the same situation, and actively listening to the other’s viewpoint helps
neutralize what could become negative conflict.
Customer Service

“If we don’t take care of our customers, someone else will.”
Unknown
Health insurance specialists serve as a direct point of contact for a provider’s
patients, and they are responsible for ensuring that patients receive an excellent
level of service or assistance with questions and concerns. It is equally important
to remember that colleagues deserve the same respect and attention as patients.
Diversity Awareness
“The real death of America will come when everyone is alike.”
James T. Ellison
Diversity is defined as differences among people and includes demographics
of age, education, ethnicity, gender, geographic location, income, language, marital
status, occupation, parental status, physical and mental ability, race, religious
beliefs, sexual orientation, and veteran status. Developing tolerance, which is the
opposite of bigotry and prejudice, means dealing with personal attitudes, beliefs,
and experiences. Embracing the differences that represent the demographics of
our society is crucial to becoming a successful health professional.
Leadership

“The difference between a boss and a leader: a boss says, ‘Go!’ A leader says,
‘Let’s go!’”
E. M. Kelly

Leadership is the ability to motivate team members to complete a common
organizational goal display. Leaders have earned the trust of their team, which is
the reason the entire team is able to achieve its objective and set the standard for
productivity, and even revenue goals. Interestingly, the leader identified by the team
might not be the organization’s manager or supervisor. Leaders emerge from within
the organization because they have demonstrated beliefs, ethics, and values with
which team members identify. Managers who are not threatened by the natural
emergence of leaders benefit from team harmony and increased productivity. They

receive credit for excellent management skills, and they begin the process to leadership
when they begin to acknowledge the work ethic of the team and its leader.
Managing Change
“If we don’t change, we don’t grow. If we don’t grow, we aren’t really living.”
Gail Sheehy

Change is crucial to the survival of an organization because it is a necessary
response to implementation of new and revised federal and state programs,
regulations, and so on. While the organization that does not embrace change
becomes extinct, such change disrupts the organization’s workflow (and productivity)
and is perceived as a threat to employees. Therefore, it is the role
of the organization’s leadership team to provide details about the impending
change, including periodic updates as work processes undergo gradual revision.
Employees also need to understand what is being changed and why, and the
leadership team needs to understand employees’ reluctance to change.
Productivity


“Even if you are on the right track, you’ll get run over if you just sit there.”
Will Rogers
Healthcare providers expect health insurance and medical coding/billing
specialists to be productive regarding completion of duties and responsibilities.
Pursuing professional certification and participating in continuing education
helps ensure individual compliance with the latest coding rules and other
updates. Increased knowledge leads to increased productivity and performance
improvement on the job.
Professional Ethics

“Always do right—this will gratify some and astonish the rest.”
Mark Twain
The characteristics of a successful health insurance specialist include an
ability to work independently, attention to detail, ability to think critically, and
a strong sense of ethics. The American Heritage Concise Dictionary defines ethics
as the principles of right or good conduct, and rules that govern the conduct
of members of a profession.
Team-building

“Michael, if you can’t pass, you can’t play.”
Coach Dean Smith to Michael Jordan in his freshman year.

Colleagues who share a sense of community and purpose work well together
and can accomplish organizational goals more quickly and easily because they
rely on one another.

This means colleagues provide help to and receive help
from other members of the team. Sharing the leadership role and working
together to complete difficult tasks facilitates team-building.
Telephone Skills for the Healthcare Setting

The telephone can be an effective means of patient access to the healthcare
system because a healthcare team member serves as an immediate contact for
the patient. Participating in telephone skills training and following established

protocols (policies) allow healthcare team members to respond appropriately to
patients. When processes for handling all calls are developed and followed by
healthcare team members, the result is greater office efficiency and less frustration
for healthcare team members and patients. Avoid problems with telephone communication
in your healthcare setting by implementing the following protocols:

Establish a telephone-availability policy that works for patients and office
staff. Telephone calls that are unanswered, result in a busy signal, and/or force
patients to be placed on hold for long periods frustrate callers. The outcome can
be a receptionist who sounds impatient and too busy to properly resolve callers’
questions and concerns.

 Avoid such problems by increasing telephone availability
so that the calls are answered outside of the typical 9 to 5 workday (which often
includes not answering the telephone during lunch). Consider having employees
(who have undergone telephone skills training) answer calls on a rotating basis
one hour before the office opens, during the noon hour, and one hour after the
office closes. This telephone protocol will result in satisfied patients (and other
callers) and office employees (who do not have to return calls to individuals who
otherwise leave messages on the answering machine).

Set up an appropriate number of dedicated telephone lines (e.g., appointment
scheduling, insurance and billing) based on the function and size of the
healthcare setting. Publish the telephone numbers on the office’s Web site and
in an office brochure or local telephone directory, and instruct employees to
avoid using the lines when making outgoing calls. Another option is to install
an interactive telephone response system that connects callers with appropriate
staff (e.g., appointment scheduling, insurance and billing, and so on) based on
caller keypad or voice responses to instructions provided.

Inform callers who ask to speak with the physician (or another healthcare
provider) that the physician (or provider) is with a patient. Do not state, “The
physician is busy,” which implies that the physician is too busy for the patient
and could offend the caller. Ask for the caller’s name, telephone number, and
reason for call, and explain that the call will be returned.

Assign 15-minute time periods every 2–3 hours when creating the schedule,
so physicians (and other healthcare providers) can return telephone calls. The
receptionist will be able to tell callers an approximate time when calls will be
returned (and patient records can be retrieved).

Physically separate front desk check-in/check-out and receptionist/patient
appointment scheduling offices. It is unlikely that an employee who manages the
registration of patients as they arrive at the office (and the check-out of patients
at the conclusion of an appointment) has time to answer telephone calls. Office
receptionists and appointment schedulers who work in private offices will comply
with federal and state patient privacy laws when talking with patients.


In addition, appointment scheduling, telephone management, and patient check-in
(registration) and check-out procedures will be performed with greater efficiency.
Require office employees to learn professional telephone skills. Schedule professional
telephone skills training as part of new employee orientation, and arrange
for all employees to attend an annual workshop to improve skills.

Training allows everyone to learn key aspects of successful telephone communication, which
include developing an effective telephone voice that focuses on tone. During a
telephone conversation, each person forms an opinion based on how something
is said (rather than what is said). Therefore, speak clearly and distinctly, do not
speak too fast or too slow, and vary your tone by letting your voice rise and fall
naturally. The following rules apply to each telephone conversation:

● When answering the telephone, state the name of the office and your name (e.g.,
“Hornell Medical Center, Shelly Dunham speaking”).
● Do not use slang (e.g., nope, yep, uh huh) or healthcare jargon (e.g., ICU—the
patient hears “eye see you”).

● Use the caller’s name (e.g., Betty Smith calls the office, stating her name as soon
as her call is answered, and the receptionist asks, “How may I help you today, Mrs.
Smith?”).
● Provide clear explanations (e.g., the doctor will return your call between 3 and
4 p.m. today.).
● Be pleasant, friendly, sincere, and helpful. (e.g., smile as you talk with the caller
and your tone will be friendly) (figure 1-1).
● Give the caller your undivided attention to show personal interest, and do not
interrupt.
● Before placing the caller on hold or transferring a call, ask him or her for permission
to do so (e.g., “May I place you on hold?,” “May I transfer you to the appropriate
office?”).
● When the individual with whom the caller wants to talk is unavailable, ask if you
can take a message (e.g., “Dr. Smith is with a patient right now. May I take a
message and have him return your call after 3 p.m.?”).
● Use a preprinted message form (or commercial message pad) when taking a message
(figure 1-2).
Professional Credentials
The health insurance specialist who becomes affiliated with one or more
professional associations (Table 1-4) receives useful information available in
several formats, including professional journals and newsletters, access to
members-only Web sites, notification of professional development, and so on.
A key feature of membership is an awareness of the importance of professional
certification. Once certified, the professional is responsible for maintaining that
credential by fulfilling continuing education requirements established by the
sponsoring association.