Trillium Named 2026 SETWorks Inspiring Progress Innovation Award Winner
A new job development roadmap helped Trillium turn individual expertise into a resource the entire team can use.
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Most advice on how to attract and retain billing specialists focuses on generic tips like “pay competitively,” “offer flexibility,” and “create a good company culture.”
Those things matter, of course.
But IDD billing is unusually hard to hire for because the job requires more than billing experience. You need someone who understands not only the technical side of things, but also the specifics of your programs and payers.
And once you find someone who knows all of that, keeping them isn’t easy. Burnout is real, especially when one person becomes the go-to for every question and billing problem.
In this article, we’ll look at what makes a good IDD billing specialist and how IDD providers can attract and retain them.
Contents
What makes a good billing specialist?
The best billing specialists are detail-oriented, organized problem-solvers who can navigate complex payer and program requirements.
When it comes to IDD specifically, billing staff need to understand Medicaid waivers, authorizations, service documentation, electronic visit verification (EVV), payer requirements, service codes, and the realities of how services are delivered.
They also need to be comfortable investigating problems that don’t have an obvious answer — for example, when a payer rejects a claim because documentation doesn’t match up.
That combination of billing expertise and IDD-specific knowledge is what makes an IDD billing specialist so valuable and so hard to replace.
Are billing specialists in demand?
Billing specialists are already in demand, and the need for billing specialists is expected to grow by 8% from 2025 to 2035. Pay is also competitive, with the average medical biller earning $51,140 in 2025.
For IDD providers, the challenge is even greater. You’re not necessarily competing for someone who knows how to submit a claim. You’re looking for someone who understands particular Medicaid programs, waivers, and IDD services, which significantly narrows the pool.
How can IDD providers attract and retain billing specialists?
Since the pool of experienced IDD billing specialists is already small, providers need to think beyond the traditional billing job description. That means widening their search to include different candidates, creating opportunities for employees to grow, and making the job itself more sustainable.
1. Stop looking exclusively for “billing specialists”
Service coordinators, schedulers, payroll professionals, or even experienced DSP supervisors can all be great candidates for a billing specialist role. These individuals already understand things like documentation, authorizations, and the types of services you deliver.
Moving into billing can give an employee who already knows your organization and the IDD industry a new career path, especially if they’re looking to move away from direct support. And in many cases, it’s easier to teach the billing component than it is to teach an experienced medical biller the entire IDD industry from scratch.
2. Expand your search beyond your zip code
IDD billing is highly state- and program-specific. But that doesn’t mean that the best person for the job lives within 30 miles of your office.
Someone who already knows your state’s Medicaid waiver billing requirements will need significantly less training than an experienced local medical biller who has never touched IDD billing.
3. Hire problem solvers, not just experienced billers
IDD billing specialists spend an enormous amount of time answering questions like: Why didn’t this service bill? Why did these units exceed the authorization? Why doesn’t EVV match? Why did this payer reject something they paid last month? That means a candidate who enjoys solving problems may outperform someone with five years of conventional healthcare billing experience.
4. Build a backup before you need one
Every organization has that one employee who knows exactly how a certain payer works or which field to check first when a claim gets denied.
While that expertise is incredibly valuable, it also makes it virtually impossible for this person to take PTO. Not to mention, it puts your organization at risk if they put in their notice. Cross-training someone in their role not only protects your organization, but also gives other employees a chance to build new skills and take on more responsibility.
5. Create a billing knowledge base
Along the same lines, it’s important to get specialized billing knowledge out of your expert’s head and into a knowledge base. That means documenting all the weird payer quirks, state-specific exceptions, contacts, workarounds, and recurring denial reasons that seasoned staff have learned over time. This not only speeds up onboarding, but also relieves experienced employees from being the only person who can answer every question.
6. Give billing specialists somewhere to go besides management
Good billing specialists become more valuable as they gain specialized knowledge about your payers, programs, and processes. But not everyone wants to manage people.
So if the only way for a billing specialist to get a higher salary or title is to become a manager, you may eventually lose them. Instead, consider creating career paths that allow your best billers to advance without supervising people — for example, becoming a Senior Billing Analyst or Revenue Cycle Lead.
7. Make continuing education part of the job, not homework
Medicaid rules and waiver requirements change regularly. IDD billing specialists need to stay on top of these changes in order to do their jobs well, but keeping up with each new requirement takes time that most simply don’t have.
Providers who want to retain experienced billing specialists should build in time for continuing education. That means giving staff paid time to attend state webinars, Medicaid updates, payer trainings, and industry conferences. Ongoing learning should be part of the role instead of something employees are expected to squeeze in around their existing workload.
8. Give billing specialists tools that make their jobs easier
A lot of billing work is fixing problems that could have been caught earlier in the process, like missing documentation, EVV discrepancies, and authorization issues.
The right technology can help prevent some of that work from reaching the billing team in the first place. “Accessible QA processes can catch many kinds of billing errors before they go undetected or delay payment,” explains SETWorks Billing Support Specialist Sarah Oliason. “That’s especially important for providers when timely, accurate reimbursement can be critical for an organization’s financial survival.”
9. Reduce the number of billing roles you need to fill in the first place
When service delivery, authorizations, EVV, documentation, and billing all happen in disconnected processes, billing specialists can end up spending a lot of time fixing problems and moving information between systems. And the more manual work your billing process requires, the more people you need to keep up with it.
Before replacing a billing specialist who leaves, take a look at what they’re spending their time on. Are they entering the same information into multiple systems, manually checking documentation, or reconciling EVV clock in/outs? Those tasks take time, but they don’t necessarily require billing expertise. Instead, look for opportunities to use better workflows and technology to reduce that manual work before adding to your headcount.
Billing shouldn’t depend on a single person
At the end of the day, what most IDD providers need isn’t a better way to attract and retain billing specialists. It’s a billing operation that’s doesn’t depend on a single person to keep everything running.
Hiring is part of that, but so is cross-training, documenting institutional knowledge, and reducing the amount of manual work that falls on your billing team. The more you can outsource to technology, the less pressure falls on any one person.
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