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Employee retention strategies for medical billing companies

Facing high employee turnover? Unlock employee retention and business success with these tips for medical billing companies.

medical billing employee retention strategies

At a Glance

  • Employees, and employee retention, are an important part of medical billing company success.
  • Employee turnover is expensive, both because you have to invest in hiring replacements and because you risk client relationships.
  • The 4 Ps of billing employee retention are people, processes, payroll, and perks and benefits.

There’s an underlying factor to your medical billing company’s success: your employees. They’re the foundation of your business and can make or break it. When your business faces high turnover, it’s on shaky ground.

Aimee Heckman, a healthcare consultant with more than 25 years of experience, unpacks strategies to boost employee retention, ensuring your team remains happy, efficient, and, most importantly, intact. 

The following is a summary of Heckman's the on-demand webinar “Best Practices for Employee Retention for Billing Companies.”

Why is employee retention important? What’s the cost of high turnover?

Employee retention = client retention and overall business success. 

High employee turnover hurts your business — even more than you might think. It’s not just the internal cost of hiring and training new employees. Each team member brings value to your business, especially in healthcare. Both their skill set and the knowledge and stability they bring to your business are valuable.

Take these examples of how frequently losing employees hurts your business:

  • Decreased productivity: Losing an employee disrupts the workflows for which they’re responsible and in which they’re involved. It also takes new employees weeks or months to get up to speed. 
  • Lost institutional knowledge: Even though you likely have processes and pertinent client information documented, most businesses have institutional knowledge. It’s all that unwritten information on clients, procedures, systems, and industry best practices that makes long-term employees successful. You lose it every time an employee leaves. 
  • Increased training and recruitment costs: When employees leave, there’s a risk of losing money. Being short-staffed and spending time recruiting and training new employees can lead to lost revenue.
  • Low morale and poor culture: The rest of your team notices when turnover is high. They likely have to pick up extra work to fill the gaps or assist with training. Overall, it creates a feeling of instability. 

The Society for Human Resource Management estimates that the cost of losing an employee and replacing them is equivalent to 6 to 9 months of salary or wages in recruiting and training.

That’s not the only impact. High turnover can also impact your billing clients and how they perceive you. 

Here are a few ways it hurts clients:

  • Inconsistency in the quality of service: Whether you’re short-staffed or training a new employee, service could dip enough for clients to notice.
  • Disrupted client-employee relationship: Good clients will likely build long-standing relationships with your employees. If they never get to know your employees because of high turnover, you eliminate a crucial piece of the relationship.
  • Decreased confidence in your services: Again, if clients constantly have to work with new employees, they may lose confidence in your stability. This is especially true if they feel the effects through increased errors.
  • Desire for a more experienced company: If all your employees are new, and there’s not a lot of tenure in your staff, clients may turn to more experienced competitors.

It’s your team members who are out there forging bonds with your clients. They’re learning and navigating unique billing procedures, reducing errors, and ensuring reimbursements happen like clockwork. It’s their friendly voices and familiar names with which your clients connect. When those connections disappear, clients feel unstable and might just lose faith in your business.

The 4 Ps of employee retention

Aimee Heckman never wanted to run a billing company. She says she’s not a good biller, but her talent lies in creating great ones.

Heckman recommends the 4 Ps of employee retention:

  • People
  • Processes
  • Payroll
  • Perks and benefits

Let’s dive in.

People: How to find employees that will last

By far the most important, hiring the right people is critical to retaining them. It’s a competitive talent market out there, so you have to think strategically about who you want to hire and how you’re going to attract (and keep) them.

Hiring the right people is critical to retaining them. ”

When it comes to hiring, Heckman asks you to consider hiring for what she calls “brain and work ethic” over experience. She says she rarely hires for experience and staffs her team with people who have little experience in the medical billing field. Instead, she seeks people with transferable skills who will fit within her team.

What’s more important: experience, or brains and work ethic?

Let’s explore the pros and cons of hiring experienced billers.

Pros of experienced billers:

  • Theoretically, they require less training: You still need to vet experienced billers to make sure they know basic codes like CPT and ICD (and not just HIPAA). They’re likely more familiar with terminology, requirements, and industry knowledge.
  • It’s faster to onboard them: Since they have some knowledge of medical billing practices, they should only need some software and internal systems training.
  • They need less direct supervision: Once you get them up and running, you get to be more hands-off.

Cons of experienced billers:

  • They typically require higher salaries: It’s justifiable. With their years of experience, they should be more productive and require less onboarding.
  • They might have bad habits: Hiring an experienced biller means you risk bringing someone on with their own way of doing things. You’ll have to find those habits and train them to follow your process. 
  • They might be resistant to change: It’s even more costly if they think their way is the right way. If they’re unteachable, you’re in for an uphill climb.

The positives and negatives go both ways. But hiring for work ethic doesn’t mean hiring a brand new grad. It could also mean you hire from outside the billing or medical industries altogether. Here are the pros and cons of hiring for brains and work ethic.

Pros of hiring for brains and work ethic:

  • They have a clean slate: A hire that’s new to the billing industry won’t have any bad habits, and you can train them to do things your way.
  • They’re open to new tasks: They understand they’re learning and might be more open to taking on responsibilities. They’re also less likely to say, “That’s not my job.” They might even be enthusiastic about learning new skills.
  • They have lower salary expectations: New hires understand that they’re getting on-the-job training in a new field, so they’ll likely ask for salaries that reflect it. 
  • You can get funds to supplement on-the-job training: Local agencies often pay for some on-the-job training, which could help offset costs. You must apply and meet various demands, but it’s worth looking into in your area.

Cons of hiring for brains and work ethic:

  • It requires more training up front: You’ll spend more time showing new hires the ins and outs of the job and the industry. 
  • They require more direct supervision: Even with extensive training, you’ll need to check in periodically to ensure they’re doing everything correctly and answer any questions that pop up.
  • You risk losing the time you invested: The time you spend training new employees is really an investment in your business, and if they turnover quickly, you could lose it.

Experience or brain and work ethic, there’s no one right way to hire employees. You probably need a combination of both to help you build your dream billing team with true staying power.

How to find your billing dream team

Now that you know who you need to hire, you have to find them. Start by building out specific job requirements for each role. Decide whether you’re hiring for experience or brains and work ethic to help you narrow down applicants.

Here are some common places to find job candidates:

  • Online job boards
  • Social media
  • School boards
  • Online recruiters
  • Referrals

Remember, hiring the right people for your medical billing practice is the best tactic to prevent employee turnover.

Processes: How to set employees up for success

Don’t just give new employees a few days of training and turn them loose. There are a few things you can do upfront that will increase employee retention and improve your team overall.

Identify employees’ natural skills

Heckman suggests assigning tasks and workflows based on an employee’s natural abilities, not just their learned skills. 

For example, you shouldn’t stick a social butterfly in the corner to post charges all day. They won’t be happy in a role disconnected from people, and their productivity will decrease. Instead, put them in accounts receivable follow-up. They’ll get to interact with people more frequently and can use their outgoing personality more effectively.

While you may not be able to match people’s personalities and tasks 100% of the time, your employees will be happier and more productive when you consider them.

Watch now
Watch the webinar to see how Aimee Heckman organizes her team to match their personalities with their skills and workflows.
Learn Heckman's process

Cross-train everyone

At some point, every employee will be unavailable for one reason or another. It’s critical to the flow of your business that every employee has a backup. They’ll have peace of mind that they can step away due to illness or even take a vacation, knowing someone is handling their work tasks.

Evaluate your current staffing and see where and who can fill the gaps — even if you’re training employees across their primary skill set.

Create detailed protocols

Detailed protocols are critical to help manage employees and relieve their stress (and keep them happy). Start by setting up a comprehensive protocol for each account and system you use. 

Heckman’s team puts daily protocols in a Google Sheet for each client, from the payers to where to send claims — all the information someone needs to temporarily step in and take over.

Payroll: How to keep your team motivated, rewarded, and loyal

Payroll is the single biggest expense for most companies, so it makes sense that most companies want to minimize this cost as much as possible. But fair compensation is the least you can do for your employees.

Structuring compensation

Experienced billers command higher salaries, but you need to ensure they take on tasks with higher returns on investment to account for it.

Heckman recommends 90 days of paid training for brain and work ethic hires. Consider paying $0.50 to $1 an hour less during a probation period when new employees are learning the skills of the trade. Once they reach 90 days (or sooner if they’re fast learners), offer a salary review to bump up their pay. This should help cover some onboarding costs while you get them up to speed.

Raises and bonuses

Regular raises are key to employee retention. They’re great motivators and keep up with cost of living increases. Heckman recommends giving everyone annual raises at the same time every year to ensure no one slips through the cracks. 

Heckman also emphasizes the importance of bonuses to recognize employees for their hard work. Spot bonuses are great for celebrating a win, client praise, or work that goes above and beyond. It can be as simple as sending a team email publicly acknowledging the employee’s hard work and a $50 to $100 bonus. Even a Starbucks or other gift card can do wonders for motivating employees.

You can also offer a more structured bonus program. That will give employees clear goals and an incentive to reach them.

Perks and benefits

Benefits are important to employees, but costly for employers. That’s where perks come in. They can’t supplement benefits, but they go a long way to improve employee morale and prevent high turnover. 

Low-to-no-cost perks

Perks can be low or no cost to you, but they can make a big difference in your employees’ lives. Here are some quick examples:

  • Work schedule flexibility
  • Remote work options
  • Independent contractor status (if you meet state and federal requirements)
  • End-of-year bonuses
  • Gift cards


Healthcare insurance is the single biggest employee expense, but there are ways you can make it more affordable. Some small business associations offer their members lower-cost health insurance and other benefit options. Research your local area associations for opportunities.

Medical Billing Benchmark Report

Bonus employee retention tips: Hiring and firing

Who you hire for your team (and who you keep) has a huge impact on your employee turnover. That’s why Heckman recommends that you be slow to hire and quick to fire.

Why should you be quick to fire employees? Retaining poor performers negatively affects the morale of your entire team. They likely must work harder to pick up an underperformer’s slack or fix their mistakes. It’ll also impact your productivity and might even trickle down to your clients.

Heckman says that if you’re thinking about firing someone, you’ve already made the decision. You just haven’t figured out how to do it yet. Paying unemployment is cheaper than hanging on to someone who isn’t cutting it.

Strengthen your business with employee retention

You know the intricacies and challenges of running a company in the healthcare industry. Finding and keeping clients is your ultimate goal, but to do that, you need to find and keep your employees — they’re the heart of your business. And training new hires isn’t just time-consuming. It’s costly. 

Prevent employee turnover by putting time and energy into improving retention. A strong, consistent team doesn’t just retain clients — it propels your business forward.

Go deeper with the on-demand webinar “Best Practices for Employee Retention for Billing Companies.”

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Rebecca Slawter, freelance healthcare writer

Rebecca Slawter is a seasoned freelance content and copywriter focusing on healthcare and B2B SaaS. Rebecca has first-hand knowledge of the importance of connections between patients and their providers — connections that are easier to build in independent practices. Her passion for writing about healthcare is rooted in wanting to spotlight healthcare professionals and their tireless efforts, and to do what she can to improve the industry as a whole.

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