The health care industry employs 1 out of 3 workers.
Most jobs in this occupation require only a high school diploma;
however, many employers prefer to hire workers who have completed
some college courses or a degree.
Slower-than-average employment growth is expected as increased
automation of billing services reduces the need for billing
Nature of the Work
Billing and posting clerks and machine operators, commonly called
billing clerks, compile records of charges for services
rendered or goods sold, calculate and record the amounts of these
services and goods, and prepare invoices to be mailed to customers.
Billing clerks review purchase orders, sales tickets,
hospital records, or charge slips to calculate the total amount
due from a customer. They must take into account any applicable
discounts, special rates, or credit terms. A billing clerk for
a trucking company often needs to consult a rate book to determine
shipping costs of machine parts, for example. A hospital’s billing
clerk may need to contact an insurance company to determine what
items will be reimbursed and for how much. In accounting, law,
consulting, and similar firms, billing clerks calculate client
fees based on the actual time required to perform the task. They
keep track of the accumulated hours and dollar amounts to charge
to each job, the type of job performed for a customer, and the
percentage of work completed.
After billing clerks review all necessary information, they compute
the charges, using calculators or computers. They then prepare
itemized statements, bills, or invoices used for billing and recordkeeping
purposes. In one organization, the clerk might prepare a bill
containing the amount due and the date and type of service; in
another, the clerk would produce a detailed invoice with codes
for all goods and services provided. This latter form might list
the items sold, the terms of credit, the date of shipment or the
dates services were provided, a salesperson’s or doctor’s identification,
if necessary, and the sales total.
Computers and specialized billing software allow many clerks
to calculate charges and prepare bills in one step. Computer packages
prompt clerks to enter data from handwritten forms, and to manipulate
the necessary entries of quantities, labor, and rates to be charged.
Billing clerks verify the entry of information and check for errors
before the computer prints the bill. After the bills are printed,
billing clerks check them again for accuracy. Computer software
also allows bills to be sent electronically if both the biller
and the customer prefer not to use paper copies; this, coupled
with the prevalence of electronic payment options, allows a completely
paperless billing process. In offices that are not automated,
billing machine operators run off the bill on a billing
machine to send to the customer.
In addition to producing invoices, billing clerks may be asked
to handle follow-up questions from customers and resolve any discrepancies
or errors. Finally, all changes must be entered in the accounting
Billing clerks typically are employed in an office environment,
although a growing number—particularly medical billers—work at
home. Most billing clerks work 40 hours per week during regular
business hours, though about one in seven works part time. Because
billing clerks use computers on a daily basis, workers may have
to sit for extended periods and also may experience eye and muscle
strain, backaches, headaches, and repetitive motion injuries.
Training, Other Qualifications, and Advancement
Most billing clerks need at least a high school diploma. However,
many employers prefer to hire workers who have completed some
college courses or a degree. Workers with an associate or bachelor’s
degree are likely to start at higher salaries and advance more
easily than those without degrees. Employers also seek workers
who are computer literate, and in particular those who have experience
with billing software programs.
Billing clerks usually receive on-the-job training from their
supervisor or some other senior worker. Some formal classroom
training also may be necessary, such as training in the specific
computer software used by the company. Workers must be careful,
orderly, and detail oriented with an aptitude for working with
numbers in order to avoid making errors and to recognize errors
made by others. Workers also should be discreet and trustworthy,
because they frequently come in contact with confidential material.
Medical billers in particular need to understand and follow the
regulations of the Health Insurance Portability and Accountability
Act (HIPAA), which were enacted to maintain the confidentiality
of patient medical records.
A number of community and career colleges offer certificate programs
in medical billing. Courses typically cover basic biology, anatomy,
and physiology in addition to training on coding and computer
Billing clerks usually advance by taking on more duties in the
same occupation for higher pay or by transferring to a closely
related occupation. Most companies fill office and administrative
support supervisory and managerial positions by promoting individuals
from within the organization. Workers who acquire additional skills,
experience, and training improve their advancement opportunities.
With appropriate experience and education, some billing clerks
may become accountants, human resource specialists, or buyers.
In 2004, billing and posting clerks and machine operators held
about 523,000 jobs. Although all industries employ billing clerks,
the health care industry employs the most, about a third of all
billing clerks. The wholesale and retail trade industries also
employ a large number of billing clerks. Third-party billing companies—companies
that provide billing services for other companies—are employing
a growing number of billing clerks. Industries that are providing
this service are the accounting, tax preparation, bookkeeping,
and payroll services industry and the office administrative and
business support services industries. These industries currently
employ around 5 percent of the occupation, although a portion
of clerks in these industries are performing the function on their
own accounts. Another 3 percent—mostly medical billers—were self
Employment of billing and posting clerks and machine operators
is expected to grow more slowly than the average for all occupations
through the year 2014. Automated and electronic billing processes
are greatly simplifying billing and allowing companies to send
out bills faster without hiring additional workers. In addition,
as the billing process becomes simplified, other people, particularly
accounting and bookkeeping clerks, are taking on the billing function.
Strong growth in the health care industry, which employs many
billing clerks due to the complicated nature of medical billing,
will generate some jobs for billing clerks in the future. Although
growth will be limited, many job openings will occur as workers
transfer to other occupations or leave the labor force. Turnover
in the occupation is relatively high, characteristic of an entry-level
occupation that typically requires only a high school diploma.
Employment growth will occur in the expanding health care industries,
but growth will be limited as more hospitals and physicians’ offices
use contract billing companies. Contract billing companies generally
have much more sophisticated technology and software, enabling
them to produce more bills per person. In all industries, including
health care, the billing function is becoming increasingly automated
and invoices and statements are automatically generated upon delivery
of the service or shipment of goods. Bills also will increasingly
be delivered electronically over the Internet, eliminating the
production and mailing of paper bills.
Median hourly earnings of billing and posting clerks and machine
operators were $13.00 in May 2004. The middle 50 percent earned
between $10.76 and $15.86. The lowest 10 percent earned less than
$9.12, and the highest 10 percent earned more than $18.88.
Billing clerks process and send records of transactions for payment;
other occupations with similar responsibilities include payroll
and timekeeping clerks; bookkeeping, auditing, and accounting
clerks; tellers; and order clerks.
Sources of Additional Information
Information on employment opportunities for billing clerks is
available from local offices of the State employment service.