Opening a Medical Billing Company

by Cecilia

Do you have to be certificated to open a medical billing company or would it look good to your clients. I have over 17 years in the medical field doing hospital accounts receivable recovering money on unpaid claims, denial and doing appeal.

Could I offer to doctors my experience that I have as a denial recovery specialist until I finish school and get my certification as Registered Health Information Technology.

Please help!!!!!!!!!!!!!!!!!


To answer your first question – you do not have to be certified to open a medical billing business. But it does make you look more professional and credible to have certification credentials when trying to market yourself.

With regard to your second question – from what I have seen there are good opportunities working with unpaid or rejected claims. Just about every practice I’ve taken on has a lot of stranded income in claims that need attention – and nobody in the office had the time or motivation to resolve denials. Having the experience that you do with appeals and working on unpaid claims would be a great advantage in selling your services. And that can lead to winning a client for all their billing when they see how competent you are getting their accounts payable down. Many billing services don’t want to take on unpaid claims because of the amount of time and effort it takes. But if you are good at it you can probably do it efficiently.

The biggest challenge is getting paid enough to make it worth your while. When I’ve taken on these types of projects I did it to try to get a foot in the door and win them as a client for all their billing. So I wasn’t really expecting to make much from it. But you may want to market yourself as sort of an insurance aging specialist – or as you mentioned Denial Recovery Specialist – and charge accordingly for your services. I know some billing services charge significantly more – sometimes in the 15% range of payments received because of the time and effort. Your expertise in denials or appeals is considered valuable.

When quoting a price to a potential client just make sure you cover your expenses and make a fair wage for your services.

Hope this helps answer your questions.


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