Prerequisites
- Your EHR and clearinghouse selected
- A decision that in-house is right — see In-house vs outsourced RCM
- The MSO registered as an employer in that state
Define the role
At a single-biller practice, the role spans the whole cycle:
Be explicit about what is not in the role — clinical coding decisions, contract negotiation, credentialing (unless you’re combining roles deliberately).
Certifications that signal competence
Certification is a signal, not a substitute for experience. Specialty experience matters more than any credential — a biller who has worked your specialty knows its payer quirks, its common denials, and its modifier patterns.
The interview exercise that works
Hand the candidate a redacted 835 containing a CO-45, a PR-2, a CO-197 denial, and a PLB takeback. Ask them to walk you through it. You are listening for:
A candidate who handles that fluently can do the job. One who cannot will cost more than their salary in missed patient balances and unworked denials.
A second exercise: give them a claim that rejected at 277CA and ask how they’d diagnose it. You want to hear them distinguish a rejection from a denial without being prompted.
Compensation
Highly market-dependent. Directional ranges for a single experienced biller in a small practice:
Add 20–30% for benefits and payroll taxes to get loaded cost. Adjust substantially for high-cost metros and for remote hiring.
How many billers
Directional heuristics, heavily specialty-dependent:
Better than any ratio: measure the work. If claims go out same-day, rejections are worked same-day, the denial queue has nothing over 14 days, and AR is stable, you have enough. If any of those slips, you don’t.
Steps
1
Write the role description with the phase table above
2
Source for specialty experience first, certification second
3
Screen on the 835 exercise
Do this early. It eliminates candidates faster and more reliably than a resume review.
4
Check references on specifics
“What was their clean claim rate?” and “how did they handle the denial queue?” rather than “were they good?”
5
Set up the daily and weekly checklists before they start
6
Define the escalation path for documentation concerns
Your biller must be able to raise a documentation or coding concern to a clinician without going through MSO operations. This is both a compliance control and the mechanism by which a concerned employee raises an issue internally rather than becoming a qui tam relator. See Billing compliance basics.
7
Plan for coverage
A single biller is a single point of failure. Cross-train someone, or arrange overflow support before you need it.
Verify it worked
- Role description written and scoped
- Candidate screened on the 835 exercise
- Specialty experience verified with references
- Employed by the MSO, with the state registration in place
- Compensation not tied to collections volume in a way that pressures coding
- Daily and weekly checklists in place before day one
- Escalation path to a clinician defined
- Coverage plan for absence