The seat has been open for months, the applicants are not right, and the work is piling up. This is a common position and there are more options than hire-or-outsource.
An unfilled billing seat costs more than the salary, because claims age while it is empty. Options between hiring and full outsourcing include outsourcing only denials and A/R, hiring junior and outsourcing the complex work, or using a billing company temporarily while you recruit.
The intuition is that an unfilled role saves money. In billing it does the opposite, because the work does not pause — it accumulates, and it has deadlines.
Claims not submitted age before anyone has looked at them. Denials not worked approach appeal deadlines. A/R over 90 days climbs. And whoever is absorbing the work in the meantime — usually your front desk or you — is doing it instead of something else.
A seat empty for three months at $100,000 monthly collections is not a saving of one quarter of a salary. It is that saving minus whatever proportion of a quarter of your revenue ages past recovery, and the second number is almost always larger.
Experienced billers who understand denials, payer policy and your specialty are genuinely scarce, and they are being competed for by billing companies and larger groups who can pay more and offer remote work.
What is widely available is entry-level data entry. That is a different job. Someone who can post charges accurately is not the same as someone who can read a remark code, work out the root cause and argue an appeal — and hiring the first expecting the second is the most common mis-hire in this role.
The decision is usually framed as binary. It is not.
Work out what the role genuinely costs with the calculator — including payroll burden and your own management time, which together are usually a third of the real figure.
And run the audit framework on whatever is happening now. If billing was already struggling before the vacancy, hiring one person into a broken process does not fix it, and you will be having this conversation again in a year.
Send us your A/R aging report and tell us what your current setup looks like. We will tell you honestly whether you need a hire, a project, or ongoing help — and we do all three.
Request a free A/R review