My Medical Biller Just Quit. What Do I Do?
By Brad Becker, CRCR, Regional Billing Manager at AMS Solutions. 11-page printable PDF, free.
Maybe they gave two weeks’ notice. Maybe two hours. Maybe they simply stopped showing up and now someone in the office is staring at the billing system wondering what half the workqueues mean. Your first job is not replacing the person. Your first job is keeping the revenue cycle under control, because patients are still being seen, claims still need to go out, denials keep aging and payer deadlines do not care that your staffing plan just exploded.
What’s inside
- The order of operations: stabilize first, rebuild second (and why you should not panic-hire)
- The first four hours: secure practice-owned access and pull a snapshot of the revenue cycle
- Keep revenue moving: are new services still turning into claims, and where is the money already stuck?
- Temporary ownership for every billing function, in one table
- Eight questions to ask the departing biller while you still can
- The first 48 hours: figuring out what kind of problem you really have
- Hire, outsource or hybrid, and how to compare the true operating cost
- Five things not to do, red flags, and a printable 48-hour billing continuity checklist
Who it’s for
Practice owners and office managers facing a billing vacancy right now, or who want a plan on the shelf before it happens.
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The order of operations: stabilize first, rebuild second
Secure access, so the practice controls the EHR/PM system, clearinghouse, payer portals, payment access and billing files. Freeze a revenue-cycle snapshot by pulling A/R, claims, rejection, denial and collections reports before workflows change. Keep claims moving by finding unbilled encounters, held claims and rejections. Protect money already in flight by identifying old A/R, appeals, filing deadlines and high-dollar balances. And do not panic-hire: before you replace the person, understand what the person was actually doing. You may have a simple vacancy, or you may be uncovering a backlog, a process problem, a performance problem or a visibility problem.
The first four hours
Secure practice-owned access. Confirm the practice can reach the EHR and practice-management system, the 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 solve an access problem by casually sharing the departing employee’s credentials. Restore proper practice-controlled access, create or update authorized users and remove departing-user access when appropriate.
Pull a snapshot of the revenue cycle. A/R aging by payer shows what is unpaid and how old it is. Claims and charge submission shows what has actually been billed. Held or unbilled claims find encounters that never reached the payer. The rejection report finds claims that failed before adjudication. The denial report shows open payer denials and their age. Three months of collections gives a cash-flow baseline. Unapplied payments and credits find money that still needs reconciliation. Save these somewhere the practice controls; this is your “before” picture.
Keep revenue moving
Are new services still turning into claims? That is the day-one question. If the practice keeps seeing patients while nobody submits claims, the interruption has already started. Find out when the last claim batch went out, whether encounters are waiting for documentation or coding, whether claims sit in edit, hold or review queues, whether rejections are being monitored and whether anyone is reviewing payer requests for information. If you find several days of unsubmitted claims, restore the submission workflow now; do not wait for a permanent hire.
Then find the money that is already stuck: claims approaching timely-filing deadlines, denials awaiting appeal, records requests, authorization denials, credentialing or enrollment holds, large unpaid balances, workers’ compensation or liability claims needing manual follow-up, unposted payments and claims sitting in clearinghouse rejection. Prioritize 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
One of the biggest risks after a biller leaves is that everyone assumes someone else is handling things. Name a temporary owner for charge entry and claim creation, claim submission, rejections, denials, payment posting, A/R follow-up, patient billing, payer correspondence and reporting. It is fine if these assignments are temporary. It is not fine if nobody owns them.
Use the handoff window
If you still have access to the employee, ask: What do you do every day? What do you do weekly and monthly? What claims are currently giving you trouble? Which payers are causing problems? Are appeals or filing deadlines approaching? Are you tracking anything manually? What portals, spreadsheets or trackers do you use? What are you worried nobody will know to do after you leave? That last question may be the most useful of all.
The first 48 hours: what kind of problem do you have?
The resignation may have revealed it. A staffing problem means the operation is fundamentally healthy and needs a qualified person. A backlog problem means the previous biller was overwhelmed and work accumulated. A process problem means claims go out but denials, A/R or front-end errors create inefficiency. A performance problem means collections, denials or aging suggest the revenue cycle was already struggling. A visibility problem means leadership does not actually know how billing was performing. Review your A/R before you hire anyone: a healthy bank balance does not prove the billing operation was healthy. Look for large balances over 90 days, claims never followed up, repeated preventable denials, claims written off without review, unsubmitted charges or large rejection queues, enrollment problems, posting delays, no meaningful reporting and processes that lived entirely in one person’s head. If you uncover significant problems, simply hiring another biller may recreate the same environment.
Hire, outsource or hybrid?
Hiring in-house 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 and processes and reporting are already strong. Outsourcing may fit when you need immediate coverage, do not want to recruit and manage billing staff, want built-in team coverage, have A/R that needs cleanup, or need stronger denial management and reporting. A hybrid keeps front-office or charge-entry work internal with outside support for billing, A/R, denials or specialized follow-up. Compare the true operating cost, not just salary versus a percentage: payroll taxes and benefits, PTO, recruiting, training and turnover, management time and backup coverage, software, clearinghouse and equipment, continuing education, coding support and denial-management capacity.
If you hire another biller, ask how they prioritize A/R (listen for more than “oldest first”), how they manage denials (root-cause thinking, not only resubmission), how they monitor rejected claims, how they measure their own performance and what leadership should review monthly. If you consider a billing company, ask who handles the existing A/R, how claims already in process transition, how a gap in submission is prevented, what reports you will receive, who your day-to-day contact is, how denials and old A/R are managed, and what access they need and what happens if you leave.
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 continue for weeks from earlier claims while a new backlog grows. Do not give everyone the former employee’s login. Do not ignore old A/R while focusing only on new claims. Do not make a permanent decision from panic: you need immediate continuity, not necessarily an immediate permanent solution. Stabilize first, evaluate second, then decide. Red flags that need immediate attention include claims not submitted for several days, no access to the clearinghouse or payer portals, no A/R aging report, large volumes in hold or rejection, unusually high A/R over 90 days, an unknown denial rate, approaching appeal deadlines, payment posting substantially behind, unexplained major balances and undocumented processes.
The bigger question
Was the billing operation 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: better reporting and visibility, clear ownership for claims, denials, payments and A/R, documented processes and access, backup coverage for PTO, illness and turnover, and routine performance reviews instead of crisis-driven ones. Make the next resignation inconvenient, not catastrophic. The downloadable guide ends with a printable 48-hour billing continuity checklist covering access, claims, A/R, payments and responsibility.
Prefer the printable version with the worksheets and checklists? Use the form above. And if you would like a second set of eyes on your own numbers, AMS Solutions offers a no-obligation review of your A/R and recent billing performance: call 866-973-2221 or email info@ams-solutions.com.
This guide is for general operational and educational purposes. Payer rules, contracts, timely-filing limits and practice circumstances vary; results are not guaranteed.