> ## Documentation Index
> Fetch the complete documentation index at: https://mso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Hire your first biller

> Role definition, the certifications that signal competence, an interview exercise that actually works, compensation benchmarks, and staffing ratios.

Your first biller is the highest-leverage non-clinical hire you will make. They convert delivered care into collected money, and the difference between a good one and an adequate one is measured in percentage points of net collection rate.

## Prerequisites

* Your EHR and clearinghouse selected
* A decision that in-house is right — see [In-house vs outsourced RCM](/guides/billing/in-house-vs-outsourced-billing)
* The MSO registered as an employer in that state

**The biller is an MSO employee.** The MSO employs non-clinical staff; the PC employs clinicians. But **coding responsibility rests with the PC** — the biller operates the workflow and may hold a coding credential, and the clinician retains authority over what codes are assigned. Document this in the MSA. See [What an MSO can and can't do](/concepts/model/what-msos-can-and-cant-do).

## Define the role

At a single-biller practice, the role spans the whole cycle:

| Phase         | Responsibilities                                                      |
| ------------- | --------------------------------------------------------------------- |
| **Front end** | Eligibility verification, prior authorization, insurance data quality |
| **Middle**    | Charge entry, scrubbing, claim submission, rejection resolution       |
| **Back end**  | Payment posting, denial management, appeals, AR follow-up             |
| **Patient**   | Statements, balance calls, payment plans, refunds                     |
| **Reporting** | Weekly dashboard, denial root-cause tagging                           |

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

| Credential                             | Body  | Signals                         |
| -------------------------------------- | ----- | ------------------------------- |
| **CPB**, Certified Professional Biller | AAPC  | Billing process knowledge       |
| **CPC**, Certified Professional Coder  | AAPC  | Coding knowledge                |
| **CCS / CCS-P**                        | AHIMA | Coding, often facility-oriented |
| **CRCR**                               | HFMA  | Revenue cycle fundamentals      |

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:

| Do they…                                                | Signal                                |
| ------------------------------------------------------- | ------------------------------------- |
| Distinguish CO from PR correctly?                       | Fundamental. If not, stop.            |
| Recognize CO-45 as normal rather than a problem?        | Understands contractual adjustments   |
| Know a CO-197 cannot be billed to the patient?          | Understands group codes' consequences |
| Notice the PLB and explain why the deposit won't match? | Genuinely experienced                 |
| Ask what the RARC says?                                 | Thinks in specifics                   |
| Say what they'd do next with the denial?                | Operationally minded                  |

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:

| Level                              | Typical range   |
| ---------------------------------- | --------------- |
| Entry, no certification            | $38,000–$50,000 |
| Experienced, certified             | $50,000–$70,000 |
| Senior / lead, specialty expertise | $65,000–$90,000 |

Add 20–30% for benefits and payroll taxes to get loaded cost. Adjust substantially for high-cost metros and for remote hiring.

<Tip>
  **Do not tie billing compensation to collections in a way that rewards aggressive coding.** A bonus on clean claim rate, days in AR, or denial rate is fine. A bonus on total collections creates pressure on the exact judgment you want insulated. See [Billing compliance basics](/concepts/compliance/billing-compliance-basics).
</Tip>

## How many billers

Directional heuristics, heavily specialty-dependent:

| Setting                         | Rough ratio                    |
| ------------------------------- | ------------------------------ |
| Primary care, behavioral health | 1 per 4–8 clinicians           |
| Specialty, moderate complexity  | 1 per 3–5 clinicians           |
| Surgical, high complexity       | 1 per 2–4 clinicians           |
| High-volume PT/chiro            | Volume-driven; often 1 per 3–5 |

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

<Steps>
  <Step title="Write the role description with the phase table above" />

  <Step title="Source for specialty experience first, certification second" />

  <Step title="Screen on the 835 exercise">
    Do this early. It eliminates candidates faster and more reliably than a resume review.
  </Step>

  <Step title="Check references on specifics">
    "What was their clean claim rate?" and "how did they handle the denial queue?" rather than "were they good?"
  </Step>

  <Step title="Set up the daily and weekly checklists before they start">
    See [Build the billing rhythm](/start/first-90-days/build-the-billing-rhythm).
  </Step>

  <Step title="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](/concepts/compliance/billing-compliance-basics).
  </Step>

  <Step title="Plan for coverage">
    A single biller is a single point of failure. Cross-train someone, or arrange overflow support before you need it.
  </Step>
</Steps>

## 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

## Common failure modes

| Failure                                        | Consequence                                         |
| ---------------------------------------------- | --------------------------------------------------- |
| Hiring on credentials without the 835 exercise | A biller who miscodes group codes                   |
| No specialty experience                        | Long ramp, missed payer quirks                      |
| Employed by the PC                             | Cost allocation and CPOM confusion                  |
| Compensation tied to collections               | Pressure on coding judgment                         |
| No escalation path to a clinician              | Concerns go unraised, then external                 |
| No coverage plan                               | Two weeks of vacation becomes two weeks of aging AR |
| No checklists                                  | Ad hoc process that doesn't survive turnover        |


## Related topics

- [Weeks 1–4: Build the billing rhythm](/start/first-90-days/build-the-billing-rhythm.md)
- [Decide: in-house billing vs outsourced RCM](/guides/billing/in-house-vs-outsourced-billing.md)
- [Work the denial queue](/guides/billing/work-the-denial-queue.md)
- [What billers actually do](/concepts/payments/what-billers-do.md)
- [The 835: how payers answer](/concepts/payments/understanding-835s.md)
- [CARC codes (Claim Adjustment Reason Codes)](/reference/edi/carc-codes.md)
- [Group codes (CO, PR, OA, PI)](/reference/edi/group-codes.md)