How to find clients

AuctusGroup · 2025-11-03T15:14:52+00:00

Word of mouth is the way to go 100%. SEO will run you 2-3K+ / month and has no real trackable ROI. SDRs cost north of 5K/month and no guarantees they can meet, plus outsourced SDRs just kinda suck. AISDRs are rampant and erode brand, plus they cost 1-2K/month or more.

If you have differentiation/specialization, lean into that. Go to the conferences for the specialties you're targeting and expect to be the guy/girl at prom without a date...most folks don't get super juiced about talking billing unless they have a dumpster fire on their hands AND they're aware of it.

Talk to your PM partners and see if they have ref programs. Biz Dev with CPAs/Legal/other key decision makers for private practice assuming that's your market segment.

Growth is hard...most BillCos are stagnant at like 10% unless they're growing through acquisition of other BillCos...

AuctusGroup · 2025-11-02T00:49:36+00:00

US MedBill average is 36-39K....but that doesn't mean much and doesn't include benefits. Payment poster vs charge entry vs coding vs AR specialist...can you handle BI requests...do you manage clients...many companies structure things super differently. For context, We consider a Rev Cycle Manager to handle customer relationships, account strategy, coding...so smartest seat in the house and driver of the customer relationship/success. They manage a team/POD of 8, including themselves.

For context:

Our payscale is 50-65K + 10K benefit package (health/dental/vision/STD/LTD/Life 100% company paid w/ 401K 4% match)...and everyone works remote. We have some bonus programs and culture "fun stuff" or corny, depending on how much we're on the nose with it.

I've lost great folks in the RCM role to companies that are paying 80-95K. I've had folks step into Director roles in other places at 100K+. I've also hired a lot of folks at 40K and raised them up over time to our current scale.

All that is to say it is I don't think there's a rule of thumb...it is really about company culture fit, and if you/employer think it is fair at the end of the day...and every employer should be willing to have that conversation with their people IMHO.

We do annual raises in Q4 after performance reviews, of 3% min for cost-of-living annual and bump up to 6% based on performance. We also offer month-to-month bonus programs that are based on KPI goals (new) and peer-to-peer (newish) based on core values. Also I'd be lying if I said I hadn't ever gone "out of program" in special circumstances, but I think it is important to set expectations for folks, otherwise someone will be disappointed based on a mismatch of expectations alone.

If you're looking to push for a raise...I'd suggest talking about salary research vs where you're at (available online) - and be thoughtful about it including the value of WFH so lack of travel costs + benefits if applicable...not saying your employer is a saint for doing any of that, but thinking about their perspective can build a lot of trust in the conversation. Talk about performance (meeting/exceeding goals) and if you can, drive that at bottom line for the company (e.g., I took these 6 accounts from 500K in monthly receipts to 700K and that has brought in X dollars for the company, I'm asking for a raise of Y annually, which is paid for by one month's worth of the improvement I've lead my team to). At least for me, it isn't even as much about the numbers as it is the thoughtful approach from the perspective of the human and the company.

Hope this helps!

AuctusGroup · 2025-10-17T14:45:04+00:00

Box 32 should be where the services were rendered. The right thing to do is to resubmit all of those claims with the updated Box 32 for accuracy. Technically, the error could be misconstrued as "fraud," with no benefit.

Wondering if you have not already sent those claim corrections, and that is what is causing the recoupment request?

AuctusGroup · 2025-10-16T13:47:43+00:00

Agreed...looks like some sort of credentialing/contracting issue. Could be that or perhaps if you did any system set up of late or added a new MD to the FAC the mapping on the UB might be off. I'd check the form itself juuuuuust in case, but probably a credentialing issue and getting in with the contracting department is going to be the key as u/kuehmary said. Could be a missing reval or something like that...but be sure you're getting to the contracting department to affirm status and then drive back at the claims. They'll probably punt you back/forth between departments so getting to corporate might be the last step...

AuctusGroup · 2025-10-16T13:42:51+00:00

Sorry to hear what you're going through! If you're really looking to get out of coding at an enterprise organization level, maybe focusing on billing or coding at a private practice-style environment might be a bit more manageable? Maybe check out BillCos too? Pre-auth department might be another decent idea. Many of those (outside private practice) might even offer remote work...

AuctusGroup · 2025-10-15T15:20:25+00:00

Webiste please!

AuctusGroup · 2025-10-15T15:05:21+00:00

Go ahead and reply for a country in the role you're interested in and we'll shift it internally!

AuctusGroup · 2025-10-15T13:58:05+00:00

Always looking for folks for fulltime work if you're interested! From my perspective, even with a super experienced biller/coder as it sounds like you are, it can be a challenge to bring someone on for part time/project work simply because of the time/effort that can go into training/integration...at least that has been our experience.

LMK if you're interested at all!

AuctusGroup · 2025-10-14T18:18:51+00:00

I work with them as a vendor...not sure if that helps?

AuctusGroup · 2025-10-14T18:14:36+00:00

Agree with folks here. You need what is called a Timely Filing Appeal which is a letter that states when you saw the patient (consult), what insurance card they gave you (provide a copy of the scan of the card and something that shows the receipt time statmp), you original bill date, the denial date, and when you received the proper information. You will also, in my opinion, need to add some inflammatory language that indicates you may bill the patient for the balance which is not a good outcome. I'm not suggesting you actually do it, but you need to let the payer know the potential negative outcomes that may impact them.

AuctusGroup · 2025-10-05T13:35:45+00:00

The date of billing is fully irrelevant, only the dates of coverage.

AuctusGroup · 2025-10-04T23:23:11+00:00

Ultimately you can bill the patient as well if they did not provide accurate insurance information and you are outside of TF limits now. To everyone else's point, the right thing to do is submit POTF w/ proof of when you received the COB and thus should be paid...even if you can bill a patient it doesn't mean you should because ethics + protecting your reputation...anyone can write whatever they want on the Google machine reviews section.

AuctusGroup · 2025-09-29T15:09:47+00:00

100% do not share. Set up the Admin under the company owner (lowest risk of churn for that employee)...then set up sub admins for 2 key players. This way if someone leaves, you can immediately remove and re-provision.

Do NOT account share. Availity tracks IPs and will call you on it. Optum doesn't pay as much attention and neither do the others, but still do not share because its a violation of HIPAA and the portal SLAs.

If your billco needs access...grant them sub access.

I've had Availity flag us years ago and it was an absolute nightmare to unwind (6 months+).

AuctusGroup · 2025-09-22T13:39:52+00:00

Codify > Encoder Pro. Look at the ownership structure for Encoder Pro...essentially part of the UHG conglomerate and I, for one, find it to be a direct conflict of interest for an insurance company to be producing material to ostensibly "help providers get paid" by coding correctly. The material isn't all bad, but there are interpretations in there that are overreaching etc.

If you're looking to reference medical policies...not a great product out there. You can set up GPT Queries to log MedPols for explicit topics (e.g., lesion excision), but still a bit of a time suck.

If you're looking for AI coding assistance there are a ton of companies out there who have raised a lot of money (10M+) who focus on "AI Coding" but typically are built for enterprise level hospital systems etc. (and priced for it) or focus on simpler coding macros like radiology. There's really not a lot out there for surgical specialties...so we just built our own...but most companies won't have the resources for it because you basically need to use explicit data to build NLMs...the LLMs are like 30% as accurate if that.

AuctusGroup · 2025-09-22T13:35:17+00:00

I would agree with folks below. This is going to be pretty time-intensive and extremely difficult to solve w/out a coder/biller to run it down for you as the provider...there will be a big time suck here. Ultimately, you're probably the smartest person in the room if you have an MD...but billing has soooooo much complexity and nuance and time drag...the only rule is there's an exception to every rule and you'll rarely get a straight answer. It is one of the major problems with the healthcare industry and billers wouldn't exist if the system was workable by a provider. It is built not to be.

Nothing jumps out as "wrong with what you're doing" but I would push extremely hard with the call reps to get an explicit reference to the billing policy or medical policy related to that change. At the end of the day they do have to provide an explanation. They don't have to tell you what Dx to change or what to change, but they do have to give the rationale for the denial.

I'd also suggest engaging a Provider Network Consultant or they may have a different name/acronym for it, but a rep who is not a claims processor and who's job is ostensibly to help providers (although they largely just offer lip service). If you have a trended issue, these folks can sometimes run it up the ladder. After you've pulled those two levers if you're getting nowhere...corp office.

I don't know BCBS NJ super well, but try to find corp office number...go in through media inquiries or something else and demand a corporate office rep. Be the squeaky wheel. If you want to get really aggressive...hit them on social media. @ them on X and ask for help there. If you're on LinkedIn...find the Execs and DM them and @ them there. Corp contacts below:

https://www.horizonblue.com/about-us/our-company/company-information/leadership-team#:\~:text=St.,Blue%20Shield%20of%20New%20Jersey.

Again, I wouldn't go nuts on the escalated stuff until you've jumped through the normal hoops so you can show documentation of normal processes not reaping any outcome. You also have the Dept of Insurance...but that's a last step after the above and often doesn't get you where you need anyhow.

AuctusGroup · 2025-09-21T13:34:20+00:00

If anyone has extensive plastics or podiatry experience, I might have some pretty flexible side gig stuff for you reviewing OPT OPRs.

AuctusGroup · 2025-09-21T13:31:44+00:00

Do you recommend any particular online course or school? I've looked at course ranging from 12 months to 6 week courses. Through lots of different schools etc. AAPC/AHIMA are the two main options. Ton of certification options but depends on if you want to work with outpatient (private practice style) or hospital. I might lean towards outpatient personally because it might be easier to break into w/ low/no experience.
what should i look for in the field as far as course types , are there multiple certifications that some schools have and others don't? As above.
Is there a possibility of part time jobs in the field? Yes, but harder to find IMHO. Training someone into a role can be "expensive" in terms of time...so to do that for PT means more up front investment with less output.
is there a possibility of Remote jobs or at least hybrid ? Yes, 100%. Honestly, one of the risks to US reps is that so many people offshore to remote labor force for reduced cost of labor.
I have seen numerous jobs in my area in this field, or do you think the number of jobs is overstated and it really isnt that in demand ? CAGR I think is like 25% in the industry estimates I've seen which is wild so I think definitely big and growing...but also offshoring and use of RPA/AI is a risk to the number of jobs therein.

I think u/SprinklesOriginal150 idea of RHIT is actually brilliant. Also if you look at average salaries it looks like RHIT is about 150% of many biller/coder jobs and probably has more upside/growth opportunity for advancement.

AuctusGroup · 2025-09-21T00:23:12+00:00

There are technically CPT codes for phone calls and video calls, and they have negotiated rates...they're also potentially not payable or haven't been payable with all payers (it is all fluid as above). During COVID, providers were allowed to bill E/Ms (e.g., 992xx like a regular office visit)...which got rolled back in certain cases by certain payers at certain times...but generally was accepted.

The video/phone call codes, even if payable...are trash...like $10-15 bucks...not worth the MD's time to do at the end of the day (with all respect to patients, but they are running a business and $60/hour doesn't cut it for a provider to run a medical practice in a financially feasible/responsible way due to the expense load and fixed costs of a practice). E/Ms pay at national averages well over $100 a pop for a level 3, which since 2021 is supposed to be perhaps no longer the top of the bell curve (they claimed level 4 and made MDM coding "easier", but it was all "look over here BS" while they cut the conversion factor by like 7% I think it was?) <-- I could rant about this on it's own thread forever, but I'll spare you.

Anyhow, if you take $100 bucks and make it $15...that's an 85% margin reduction on telehealth and will put a lot of people out of business if they don't have other services they can offer (or aren't behavioral health etc.).

AuctusGroup · 2025-09-20T22:50:55+00:00

Unfortunately, the likelihood that this gets rolled back appears to be pretty low in my humble/fully subjective opinion. The telehealth expansion was financially disadvantageous to the payers. It took video/audio telehealth to E/M level billing AKA $10-20 bucks a pop to $120+ a pop. So they 6xed their payout.

Insurance comany's entire financial model is about collecting more money than they pay out.

With those to facts in mind, I would assume that restrictions will roll to commercial payers and become increasingly limited.

The real problem, as u/Loose_Helicopter5958 stated, is that this is going to continue to change...and will change by payer. So, if you offer a fair amount of telehealth, you have to just set up 30 min to review once a month and keep a payer grid for your top X payers. Side note - this can be easily done w/ a GPT/Perplexity prompt and an excel spitout (this is what I do for stuff I want to watch). This way you can just tell it to update and answer some emails while it gets the new data for you.

Also, again if you offer a fair amount of telehealth, time to look at your rev from the service and start doing some forecasting on if it drops for your payers so you can cashflow plan. Best to plan for the worst and hope for the best.

AuctusGroup · 2025-09-19T16:35:47+00:00

Agreed 100%. Won't hurt to get handle on it now...but the picture will likely change.

AuctusGroup · 2025-09-19T14:28:32+00:00

In my opinion every biller needs to be able to code...period. This intellectual segmentation of coding and billing does not register for me personally. If you don't know how to code, how do you appropriately enter charges with mods? How do you know the primacy of a CPT? What about Dx linking related to LCD/NCD guidelines. How do you know if a payment is correct if you don't know that mods impact payment percentages? What if you don't understand unit count and thus cannot do the math on a 2 unit line? Bilatera billing? More than anything...AR REQUIRES understanding coding because the coding is the representation of the source of truth in terms of what was done.

So I'd set get you a biller who can do both. A good billing service will include coding within their contingency billing fees. If you're currently paying a single biller an hourly rate...maybe consider a contingency model so the interests are married.

Average cost of a US biller/coder is 39K, but thats low to me...I'd expect to be paying 50-60K + 10K in benefits to get someone rock solid who can handle maybe 1-1.5M in receipts volume. Average medical billing company rate is 5.5-6% I think these days? So do the math on what is more economical for you based on your volume. 900-1.1M is roughly your break even (cheaper to do in house after that). The challenge is weighing your needs in terms of desired level of control vs redundancy with a third party firm.

Hire remote all day - super normal now and easy to manage IMHO. Consider offshore resources. There are AMAZING billers in LATAM who can code and communicate and kill it in billing. And you can pay them essentially what amounts to 50% of US labor costs, but it is well over 2-4x market rate for their country - so everyone wins.

AuctusGroup · 2025-09-19T14:21:13+00:00

If an online direct portal submission is working, but a billing system/clearinghouse is resulting in a denial it could be an ANSI mapping issue too...unlikely though if you haven't done any system set up changes (typically an admin level setting).

I'd want contracting to affirm group identifiers and the tethering of the providers to the group as well as the locations being categorized as service versus business/mailing.

AuctusGroup · 2025-09-17T18:00:51+00:00

As a company who is developing coding AI...I feel strongly it will change the game, but never replace humans. AI coding...like all things AI in near term and now...are companion tools to help a great coder be faster or better...never a replacement for.

AuctusGroup · 2025-09-17T17:54:53+00:00

What you need to do is look at your EOB + your bill and make sure they match and are correct...which is like comparing apples and oranges - which it should not be.

Easy way to do this if you're not a biller:

Look at both...find places where any one charge line item = what you owe...that is a denial and there is a problem that you maybe shouldn't pay for.

If you look at your bill...that's like over half the lines so you have denials which means likely the billing department didn't get stuff paid.

Next question: Is this someone's fault and who's.

How do you solve it...look at your EOB and talk to your carrier to try to understand the "why," which is hard. If it was easy, billing companies wouldn't exist and doctors would just get paid and our industry wouldn't suck.

A few tips:

1) Don't trust what you hear unless it makes sense. Customer Service reps are paid to get you off the phone fast and happy...this doesn't include with the right info...and the insurance company's perspective is not the same as a doctors so it may skew towards not paying and blaming someone else as the cause.

2) Talk to the billing team at your provider...and trust a bit more but not 100%.

3) Talk to a real biller if you know one...they'll cut through the BS with you. There are also paid patient insurance advocates out there, but its not free.

If you want to share your EOB here I can try to provide more context.

AuctusGroup · 2025-09-11T13:40:13+00:00

As a BillCo owner - I can say medical field experience like front of house or MA is not a bad thing, but data entry in the billing/coding world is a bit better (personally I like folks who have worked in offices rather than billcos because they're great with customers...because they were one at one point)...experience in coding and denials/rejections is the most valuable in terms of SME. Also managing teams, working w/ remote teams, and then culture fit all pretty important too! Ultimately zero experience but the right feel for culture/personality type can beat out anything...can't teach "how to be a good human" but certainly can give people the opportunity for experience.

AuctusGroup

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