Quick answer: When your medical biller quits, your first job is not replacing the person — it is keeping the revenue cycle under control. In the first four hours: secure practice-owned access to the EHR/PM system, clearinghouse, payer portals and payment systems (never by sharing the departing employee’s login), and pull a snapshot of A/R, claims, rejections, denials and collections before anything changes. In the first 48 hours: confirm new encounters are still becoming claims, find money already stuck (filing deadlines, appeals, high-dollar balances, unposted payments), assign a temporary owner to every billing function, and capture what the departing biller knows. Then figure out whether you have a staffing problem, a backlog, a process problem, a performance problem or a visibility problem — and only then decide whether to hire, outsource or run a hybrid. Stabilize first, rebuild second.
Your medical biller just quit. Maybe they gave two weeks’ notice. Maybe two hours. Maybe they simply stopped showing up, and someone in the office is staring at the billing system wondering what half the workqueues mean. A billing vacancy becomes a cash-flow problem surprisingly quickly: patients are still being seen, claims still need to go out, denials keep aging, payments keep arriving, and payer deadlines do not care that your staffing plan just exploded. Do not panic-hire. Before you replace the person, understand what the person was actually doing.
The order of operations: stabilize first, rebuild second
- Secure access. Make sure the practice controls the EHR/PM system, clearinghouse, payer portals, payment access and billing files.
- Freeze a revenue-cycle snapshot. Pull A/R, claims, rejection, denial and collections reports before workflows change.
- Keep claims moving. Find unbilled encounters, held claims and rejections so new revenue does not stop.
- Protect money already in flight. Identify old A/R, appeals, filing deadlines and high-dollar balances that need immediate attention.
The first 4 hours
1. Secure practice-owned access
Confirm the practice can reach every system the billing operation depends on: the EHR and practice-management system, clearinghouse, major payer portals, ERA and EFT information, Medicare and Medicaid portals, practice email accounts, patient-payment systems, billing vendor platforms, and shared drives, trackers and billing files. Do not let one employee’s login be the practice’s single point of failure — and do not solve an access problem by casually sharing the departing employee’s credentials. Restore appropriate practice-controlled access, create or update authorized users, and remove the departing user’s access when appropriate.
2. Pull a snapshot of the revenue cycle
| Report | Why you need it |
|---|---|
| A/R aging by payer | Shows what is unpaid and how old it is |
| Claims / charge submission | Shows what has actually been billed |
| Held or unbilled claims | Finds encounters that have not reached the payer |
| Rejection report | Finds claims that failed before adjudication |
| Denial report | Shows open payer denials and their age |
| Collections — last 3 months | Creates a cash-flow baseline |
| Unapplied payments / credits | Finds money that still needs reconciliation |
Save these somewhere the practice controls. This is the “before” picture you will measure the transition against.
Keep revenue moving: the day-one question
Are new services still turning into claims? If the practice keeps seeing patients while nobody submits claims, the revenue interruption has already started. Find out when the last claim batch went out, whether encounters are waiting for documentation or coding, whether claims are sitting in edit, hold or review queues, whether clearinghouse rejections are being monitored, and whether anyone is reviewing payer responses and requests for information. If you find several days of unsubmitted claims, restore the submission workflow now — do not wait for a permanent hire.
Find the money that is already stuck
Existing receivables may already be waiting for action: claims approaching timely-filing deadlines, denials awaiting appeal, requests for medical records, authorization-related denials, credentialing or payer-enrollment holds, large unpaid balances, workers’ compensation or liability claims needing manual follow-up, unposted payments, and claims sitting in clearinghouse rejection. Triage by age, dollar amount and deadline: a $25 claim from last week does not deserve the same attention as a $7,500 claim approaching an appeal deadline.
Assign temporary ownership
The biggest risk after a billing employee leaves is that everybody assumes someone else is handling things. Temporary ownership beats invisible ownership.
| Function | Question to answer |
|---|---|
| Charge entry / claim creation | Who makes sure completed encounters become claims? |
| Claim submission | Who sends claims and monitors transmission? |
| Rejections | Who fixes claims that failed before adjudication? |
| Denials | Who reviews payer denials and determines the next action? |
| Payment posting | Who posts ERAs, EOBs and other payments? |
| A/R follow-up | Who follows outstanding claims? |
| Patient billing | Who manages statements and patient balances? |
| Payer correspondence | Who sees letters, requests and portal messages? |
| Reporting | Who is watching collections and A/R during the transition? |
Use the handoff window: eight questions for the departing biller
If you still have access to the employee, use it — not to make their final week miserable, but to preserve knowledge that may exist only in their head.
- What do you do every day? You may uncover tasks nobody else knew existed.
- What do you do weekly and monthly? Reconciliations, statement cycles, reporting, payer-specific work.
- What claims are currently giving you trouble? Saves hours of detective work.
- Which payers are currently causing problems? They already know where the land mines are.
- Are appeals or filing deadlines approaching? Write the dates down immediately.
- Are you tracking anything manually? Do not assume everything lives in the PM system.
- What portals, spreadsheets or trackers do you use? Get the list and confirm practice access.
- What are you worried nobody will know to do after you leave? Possibly the most useful question of all.
The first 48 hours: figure out what kind of problem you have
| Type | What it looks like |
|---|---|
| Staffing problem | The billing operation is fundamentally healthy and simply needs a qualified person to take over. |
| Backlog problem | The previous biller was overwhelmed and work has accumulated. |
| Process problem | Claims go out, but denials, A/R or front-end errors create inefficiency. |
| Performance problem | Collections, denials or aging show the revenue cycle was already struggling. |
| Visibility problem | Leadership does not actually know how well billing was performing. |
Review your A/R before you hire anyone. A healthy bank balance does not prove the billing operation was healthy — collections can continue for weeks from claims submitted earlier while a backlog quietly grows. Look for large balances over 90 days, claims never followed up, repeated preventable denials, write-offs without adequate review, unsubmitted charges or large rejection queues, payer-enrollment problems, posting delays, no meaningful reporting, and processes that lived entirely in one person’s head. If the operation is healthy, replacing the employee may be straightforward. If you uncover significant A/R or workflow problems, hiring another biller may simply recreate the same environment. (Not sure how to read the aging report? Start with how much A/R over 90 days is too much.)
Hire, outsource or hybrid?
There is no universal answer; both in-house and outsourced models work well. The decision should reflect the practice you actually have, not the panic of the moment.
| Hiring in-house may fit when… | Outsourcing may fit when… |
|---|---|
| You want direct day-to-day control; existing leadership can manage billing performance; volume justifies dedicated staff; backup coverage can be maintained; processes and reporting are already strong. | You need immediate billing coverage; you do not want to recruit and manage billing staff; you want built-in team coverage; existing A/R needs cleanup; you need stronger denial management or reporting. |
A hybrid is also an option — some practices keep front-office or charge-entry work internal and use outside support for billing, A/R, denials or specialized follow-up. Whichever way you lean, compare the true operating cost, not salary versus a percentage: salary, payroll taxes and benefits; PTO, recruiting, training and turnover; management time and backup coverage; billing software, clearinghouse and equipment; continuing education, coding support and denial-management capacity. The goal is not to prove one model is cheaper; it is to compare the whole operating model honestly. See how outsourced medical billing works and what billing services should cost.
If you hire another biller, ask how they actually work
How do you prioritize A/R? (Listen for more than “oldest claims first.”) How do you manage denials? (Root-cause thinking, not just resubmission.) How do you monitor rejected claims? (They should separate rejection from denial workflows.) How do you measure your own performance? What should leadership review monthly?
If you consider a billing company, make the transition visible
Who handles the existing A/R? How do you transition claims already in process? How do you prevent a gap in claim submission? What reports will we receive, and can we see samples? Who is our day-to-day contact? How are denials and old A/R managed? What access do you need, and what happens if we eventually leave? And ask who will actually be doing the work.
Five things not to do
- Do not wait several weeks before looking at billing. Revenue keeps aging while you recruit.
- Do not assume everything was fine because money was coming in. Collections lag; a new backlog can grow silently.
- Do not give everyone the former employee’s login. Restore access through proper user accounts and administrative controls.
- Do not ignore old A/R while focusing only on new claims. Protect today’s revenue and the money already owed.
- Do not make a permanent decision from panic. You need immediate continuity, not necessarily an immediate permanent solution. Stabilize, evaluate, then decide.
Red flags that need immediate attention
Claims not submitted for several days; nobody can access the clearinghouse or major payer portals; you cannot produce an A/R aging report; large volumes of claims in hold or rejection; A/R over 90 days unusually high; nobody knows the current denial rate; appeals or filing deadlines approaching; payment posting substantially behind; nobody can explain major outstanding balances; billing processes never documented. Any of these means the resignation exposed something bigger than a vacancy.
The 48-hour billing continuity checklist
| Area | Confirm |
|---|---|
| Access | EHR/PM, clearinghouse, major payer portals and payment/ERA access confirmed; practice-owned billing files secured; departing employee’s access reviewed |
| Claims | Last submission date identified; unbilled encounters, held claims, clearinghouse rejections and documentation delays reviewed |
| A/R | Aging report pulled; A/R over 90 reviewed; high-dollar claims, appeal and filing deadlines, major payer problems identified |
| Payments | Posting status confirmed; unapplied payments reviewed; EFT/ERA workflow confirmed; patient balances reviewed |
| Responsibility | Temporary owners assigned for claim submission, rejections, denials, payment posting, A/R follow-up and reporting |
The goal in the first two days is not perfection. It is making sure the practice can see the work, access the systems and assign ownership before anything important disappears into the cracks.
The bigger question: was billing healthy before the biller quit?
If yes, you may simply need a new person. If no, you have a chance to rebuild the process rather than merely replace the employee — with better reporting and leadership visibility, clear ownership for claims, denials, payments and A/R, documented processes and system access, backup coverage for PTO, illness and turnover, the right mix of staffing, outsourcing or hybrid, and routine performance reviews instead of crisis-driven ones. Make the next resignation inconvenient, not catastrophic. Your biller quit; your revenue cycle does not have to.
Need help keeping claims moving? AMS Solutions can evaluate the current billing workflow, outstanding A/R, claim status and transition needs so you know what needs attention now and what can wait. Request a no-obligation billing and A/R review or call (866) 488-6308. Physician-founded in 1992, Dallas-headquartered, in-house global team, US-led — medical billing, credentialing and A/R recovery under one roof.
FAQs
What is the first thing to do when a medical biller quits?
Secure practice-owned access to the EHR/PM system, clearinghouse, payer portals and payment systems, then pull a snapshot of A/R aging, claims submitted, held claims, rejections, denials, three months of collections and unapplied payments before any workflow changes. Replacing the person comes after the revenue cycle is stable.
How long can a practice go without submitting claims?
Not long. Every unbilled day adds to the collection cycle and moves claims toward timely-filing limits, and collections from earlier claims can mask the gap for weeks. If you find several days of unsubmitted claims, restore the submission workflow immediately rather than waiting for a permanent hire.
Should we share the departing biller’s login so work can continue?
No. Restore access through proper practice-controlled user accounts and administrative controls, and remove the departing employee’s access when appropriate. Shared credentials create security and audit problems and leave the practice with a single point of failure.
Should we hire another biller or outsource after a resignation?
Decide after you know what you are inheriting. If A/R, denials and reporting are healthy, a straightforward hire may be right. If the review uncovers backlog, recurring denials or no visibility, hiring one replacement can recreate the same environment; outsourcing or a hybrid model adds team coverage and reporting. Compare the full operating cost of each, not salary versus a percentage.
What should I ask the departing biller before they leave?
What they do daily, weekly and monthly; which claims and payers are currently causing trouble; which appeals or filing deadlines are approaching; what they track manually; which portals, spreadsheets and trackers they use; and what they are worried nobody will know to do after they leave.
