Why Medical Billing and Coding Roles Are Hardest to Fill in Healthcare Staffing

When a March 2023 MGMA Stat poll asked medical group leaders directly which revenue cycle role was hardest to hire, medical coders topped the entire list at 34%, ahead of billers at 26% and schedulers at 18%. That particular ranking holds up well beyond just a single isolated survey result. Nearly 9 in 10 healthcare executives report genuine shortages in medical billers and coders specifically, and a separate study of physician practices cites medical coders as the single most difficult position to fill across the entire practice, physicians themselves included in that comparison.

This post walks carefully through why billing and coding roles consistently rank at the very top of healthcare’s hardest-to-fill list: a formal certification process that takes real time and genuine money to complete, a shrinking supply of qualified coders meeting rising demand driven by an aging population, a wave of pandemic-era burnout and early retirement that thinned out the existing workforce, and a remote-work shift that turned what used to be a purely local hiring problem into national competition for the same small pool of credentialed people.

TL;DR

• The data consistently points to coding and billing as healthcare’s hardest hires. MGMA’s 2023 survey found 34% of medical group leaders cite coders as their hardest revenue cycle role to fill, ahead of billers at 26%, and healthcare overall already averages 49 days to fill any role against a 36-day average across all US industries combined into 1 figure.
• A real certification barrier sits between a candidate and the job. The Certified Professional Coder credential requires passing a rigorous multiple-choice exam covering CPT, ICD-10-CM and HCPCS Level II coding systems, and candidates without 2 full years of prior experience only qualify for an apprentice-level credential rather than the full, employer-preferred certification most job postings specifically and consistently ask for.
• Supply and demand have moved in opposite directions at the same time. The Bureau of Labor Statistics projects roughly 14,900 coding openings a year with demand growing 7% between 2021 and 2031, while pandemic-era burnout, early retirement and a shift toward remote work have simultaneously shrunk and redistributed the existing pool of qualified coders and billers across the country.

The Data Behind the Claim

Every row in this table points toward the same conclusion from a different angle. Healthcare hiring already runs slower than the average industry, and within healthcare specifically, billing and coding consistently rank above nearly every other role leaders are asked about, doctors and nurses included in some of the broader surveys measuring this. The MGMA data on revenue cycle staffing reinforces that pattern across coders, billers and schedulers rather than relying on a single isolated hiring complaint. That consistency across multiple independent surveys, rather than a single outlier data point, is what makes the pattern worth examining structurally instead of dismissing as a temporary blip.

Why Coding and Billing Rank Above Other Revenue Cycle Roles

The gap between coding and billing roles versus other revenue cycle positions like scheduling comes down to a genuinely straightforward difference in what the job actually requires of someone before they can even start working. A scheduler needs to learn a specific practice’s own software and day-to-day workflow, a process that typically takes just a few weeks of on-the-job training regardless of prior experience coming in. A medical coder needs to already hold, or be actively working toward, a nationally recognized certification that demands months of dedicated study, a rigorous standalone exam, and ongoing continuing education just to maintain afterward, all before most employers will seriously consider a given candidate for the role at all.

That real difference in required preparation before day 1 helps explain why coding specifically outranks billing in most surveys of hiring difficulty, even though both roles technically sit inside the same broader revenue cycle shortage described by the data. VALiNTRY’s healthcare administrative staffing services specifically include medical billers, coders and other nonclinical support positions, reflecting how these jobs sit within a specialized healthcare hiring market. Billing work draws on a genuinely wide labor pool overall, since strong administrative and customer service skills transfer reasonably well into a billing role given proper training, while coding work requires a specific, credentialed skill set that has no real practical substitute available, which is exactly the kind of narrow, non-transferable requirement that consistently produces longer, harder searches across almost any industry you look at.

The Certification Barrier: What It Actually Takes to Become a Coder

The CPC Credential Sets the Standard The Certified Professional Coder certification, offered by the American Academy of Professional Coders, remains the credential most physician offices, hospitals and outpatient centers specifically look for when hiring a new coder. AAPC’s current CPC certification requirements include a 100-question examination covering CPT, ICD-10-CM and HCPCS Level II coding systems, along with anatomy, medical terminology and detailed coding guidelines, with a passing score around 70% required and an exam fee that runs several hundred dollars for each individual attempt.

Passing the Exam Isn’t the Whole Story A candidate who passes the CPC exam without at least 2 full years of genuine on-the-job coding experience receives a CPC-Apprentice designation instead of the full CPC credential, and many employers treat that distinction as a meaningfully different qualification altogether when reviewing applications. That real gap between certified-in-theory and certified-with-experience means even a newly credentialed coder often isn’t considered fully qualified by hiring managers reviewing their application, which narrows the pool of genuinely ready candidates well below the total number of people who technically hold some form of coding certificate.

The Credential Requires Ongoing Investment to Keep Maintaining CPC certification requires an active annual membership with the credentialing body and 36 continuing education units every 2 years, which turns the barrier to entry into an ongoing professional commitment rather than a 1-time hurdle. Training programs preparing candidates for the exam commonly run into the thousands of dollars in total cost, which adds a real, tangible financial threshold on top of the significant time investment required before someone can even sit for the credentialing exam in the first place.

A Shrinking Supply Meeting Rising Demand

• Demand is growing steadily and predictably. Current Bureau of Labor Statistics projections for medical records specialists continue to show faster-than-average employment growth, driven in part by increasing healthcare use and the need to process expanding volumes of health information and records.
• The supply side hasn’t kept pace with that growth. Roughly 14,900 coding positions open every single year according to federal labor data, and industry voices describe a consistent, recurring pattern where practices report openings they simply can’t fill, regardless of how genuinely competitive the posted wage itself happens to be at that specific moment of posting it live.
• Industry growth is compounding the gap further. The medical billing services market itself is projected to grow at a compound annual rate above 11% through the late 2020s, which means the pool of open positions needing qualified candidates is expanding at the same time the supply of credentialed coders and billers is struggling to keep up with existing demand.
• Practices are already feeling the practical impact. Business owners in the space describe having to delay expansion plans specifically because they can’t find enough skilled billers to staff the growth, not because of capital or demand constraints, which is a clear, unambiguous signal that the shortage functions as an active operational limit rather than a distant background statistic sitting in a report.

Burnout and Retirement Thinned the Existing Workforce

The pandemic didn’t just disrupt normal hiring patterns temporarily, it actively pushed a real share of experienced coders and billers straight out of the workforce entirely. Burnout and early retirement among healthcare administrative staff accelerated sharply both during and after the pandemic years, removing exactly the kind of experienced, already-credentialed workers that newer hires would otherwise have been able to learn from and eventually replace through ordinary, gradual workforce turnover over time. That loss compounds the certification barrier described earlier, since fewer experienced coders in the workforce also means fewer people positioned to train and mentor the next wave of CPC-Apprentice coders into fully qualified professionals.

This exodus also shifted the competitive landscape for the workers who remained. With more open positions chasing a smaller pool of experienced talent, wages for skilled billers and coders climbed, and the more experienced workers who stayed found themselves with considerably more bargaining power and more offers to choose from than they had before the pandemic reshaped the field. For an employer trying to fill a role, working within an already constrained healthcare staffing market means competing against other healthcare practices and against a genuinely tighter overall labor market, for a skill set that already had a narrow, credentialed pipeline feeding it before any of this disruption began.

Remote Work Turned a Local Hiring Problem National

Local Practices Now Compete With the Entire Country Before remote work became a standard, widely accepted option, a medical practice hiring a biller or coder was primarily competing against other local employers within realistic commuting distance. Remote work options changed that dynamic fundamentally and permanently, since a qualified coder working from home can now accept a position with any practice or billing company located anywhere in the country, which means a small practice in a rural area is effectively competing for the very same candidate pool as a large hospital system operating in a major metro market.

This Shift Cuts Both Ways for Employers A practice genuinely open to hiring remotely gains access to a much larger candidate pool than it could ever reach purely locally, and broader healthcare staffing solutions can help employers source beyond their immediate commuting market. But a practice that insists on an on-site hire, whether for workflow reasons or simple preference, now faces a shrunken local pool that’s actively being recruited away by remote opportunities elsewhere, which helps explain why on-site billing and coding roles specifically tend to sit open longer than positions with remote flexibility built in from the start.

Specialty Coding Adds Another Layer of Difficulty

Beyond the base CPC credential alone, many coding roles also require specialty-specific knowledge that narrows the already-qualified candidate pool down even further still. Coding for cardiology, orthopedics, radiology or oncology each involves genuinely distinct CPT coding requirements, documentation patterns and payer nuances that a generalist coder needs meaningful additional training to handle confidently and accurately, and practices in these specialties often specifically seek out coders who already carry that exact specialty experience rather than training a generalist coder from scratch.

This kind of specialization compounds the shortage in a way that’s genuinely easy to miss when looking only at aggregate coding statistics nationally. A national count of roughly 14,900 annual coding openings doesn’t meaningfully distinguish between a generalist role at a typical primary care practice and a specialty role requiring years of focused, hands-on experience in a single narrow area of medicine, and practices needing that specific specialty depth are effectively competing for a much smaller slice of an already-limited pool of candidates. A cardiology practice struggling hard to fill a coding role isn’t just competing against other cardiology practices either, it’s competing against every other specialty that also needs coders with deep, procedure-specific expertise, which spreads an already-thin supply of specialized talent even further across the industry.

Why Wage Increases Haven’t Solved the Problem

Employers have responded to this shortage the way most labor markets eventually do respond, by raising pay significantly, and wages for skilled billers and coders have climbed accordingly across the industry in recent years. Yet the persistent, stubborn gap between open positions and genuinely qualified candidates shows that compensation increases alone haven’t been enough to close it, which points toward the same structural pattern seen in other credentialed professions facing shortages: money can redistribute existing talent between employers, but it can’t manufacture new credentialed coders faster than training programs and the 2-year experience requirement allow them to actually enter the field.

This distinction matters directly for how a practice should think about its hiring budget. Simply offering a higher wage than a competing practice down the street might help win a specific candidate in a head-to-head negotiation, but organizations using permanent healthcare staffing still have to recruit from the same constrained national talent market. Practices that treat wage increases as their primary strategy often find themselves still struggling to fill roles even after raising pay, because the fundamental constraint isn’t that candidates are choosing not to apply for a specific wage, it’s that there simply aren’t enough fully credentialed, experienced candidates to go around in the first place, regardless of what any single employer is willing to pay for one.

What an Open Billing or Coding Role Actually Costs

These numbers connect directly to each other in practice. A vacant billing seat means denials stop getting worked inside their appeal window, aging accounts receivable keeps aging past the point where collection rates hold up, and every week that passes makes the same pile of claims measurably harder to recover. Organizations recruiting billing and revenue cycle specialists therefore face a staffing problem that can quickly become a revenue problem as well, even though the underlying revenue was genuinely collectible the whole time if someone had simply worked the claim before it aged out of a recoverable window.

Why Billing and Coding Differ From a Simple Administrative Hire

• The work involves real compliance judgment rather than simple data entry. A coder has to interpret clinical documentation and translate it into the correct combination of CPT, ICD-10-CM and HCPCS codes, a task that directly affects whether a claim gets paid, denied, or flagged for a compliance audit, which is meaningfully different from transcribing information into predetermined fields.
• Errors carry financial and regulatory consequences. Incorrect coding can trigger claim denials, delayed reimbursement, or in more serious cases, real compliance exposure tied directly to improper billing, which is exactly why employers screen so carefully for credentialed experience rather than treating the role as a simple entry-level administrative position anyone could pick up quickly on the job without real training.
• The underlying rules change constantly. CPT and ICD-10-CM codes get updated on a regular cycle, and payer-specific billing rules shift frequently enough that the continuing education requirement built into maintaining a coding credential reflects a genuine, ongoing need to stay current, well beyond a simple box-checking formality, with rules that a less specialized administrative role simply doesn’t carry.
• One hiring manager’s description captures the gap directly. A billing company executive quoted on the shortage put it plainly: she couldn’t just hire anyone off the street because the role isn’t simply about processing a claim, it requires someone who genuinely understands the underlying system well enough to get every last detail right the very first time around, consistently.

Comparing Billing and Coding to Other Hard-to-Fill Healthcare Roles

This comparison helps explain why billing and coding shortages often get less organizational attention than physician or nursing shortages, despite ranking as harder to fill in direct surveys of hiring managers. Clinical shortages draw more visible institutional investment because they touch patient care directly, while finance and revenue cycle recruiters work on shortages that show up more quietly, in denied claims and aging accounts receivable, rather than in an empty exam room, even though the underlying difficulty of the hire itself, and its eventual financial impact, can be just as significant.

What a New Coder’s First 2 Years Actually Look Like

Understanding the CPC-Apprentice pathway in a bit more detail helps explain why the certification barrier functions as a genuine bottleneck in the pipeline rather than just a minor administrative step to check off. A candidate who completes training and passes the CPC exam without prior hands-on coding experience enters the workforce carrying the apprentice designation, and that designation follows them until they can document 2 years of relevant, verified work experience in the field, typically confirmed through employer attestation or membership validation with the credentialing body.

That 2-year window creates a genuine supply constraint that compounds everything else driving the shortage. New coders first need to find that critical first opportunity at the apprentice level in the first place, since many job postings explicitly request the full CPC credential rather than accepting the apprentice version, which means a meaningful share of newly trained coders genuinely struggle to find that critical first opportunity, even after investing real time and real money to pass the exam in the first place. Employers who do decide to hire apprentices then need to provide the kind of hands-on mentorship and close oversight that gradually turns apprentice-level competence into fully credentialed proficiency, an investment that smaller practices without any dedicated training infrastructure in place often can’t easily provide entirely on their own.

The practical result is a pipeline with a genuine chokepoint sitting right at the entry level. Training programs can produce a steady supply of exam-passing candidates, but converting those candidates into fully qualified, experienced coders depends on employers willing to take on apprentices and invest in developing them, a step that many practices skip entirely by only recruiting already-experienced coders instead, which simply shifts the same competition for a limited pool of fully qualified candidates onto every other employer trying to hire the exact same way.

How Outsourcing Has Changed the Competitive Landscape

Faced with persistent, ongoing difficulty hiring in-house, a growing share of healthcare providers have shifted billing and coding work over to outsourced specialists rather than continuing to compete directly for increasingly scarce local talent every time a role opens up. Outsourced medical billing companies can pool demand from many different client practices at once, which lets them offer coders and billers considerably steadier workloads, clearer long-term career paths and often better overall compensation than a single small practice could ever realistically sustain on its own, making these companies increasingly attractive employers for the same limited pool of credentialed professionals that individual practices are trying to hire directly.

This meaningful shift changes the underlying hiring calculation for any practice weighing whether to keep building out an in-house team or move toward an outsourced model instead of continuing to compete directly. Flexible models such as accounting staff augmentation can also change how organizations cover billing-related workload without relying entirely on a traditional permanent-hire process. A practice that outsources sidesteps the direct hiring difficulty, but it also means competing indirectly with billing companies that can offer coders exactly the kind of stability and growth that makes individual, smaller practices a harder sell in the first place. For practices that do want to keep billing and coding in-house, understanding that they’re now competing against well-resourced billing companies, and against other individual practices, for that same credentialed talent is an important part of setting realistic expectations for how difficult and how long that search is likely to run.

Geographic Concentration Adds a Final Layer

Even with remote work widening the overall candidate pool considerably in recent years, coding and billing talent still isn’t distributed evenly across the entire country, and that uneven distribution shapes how difficult a specific practice’s search turns out to be. Regional markets can have very different concentrations of healthcare finance and medical billing talent, since training programs, credentialing bodies and established billing companies all tend to cluster together in certain specific regions. That means practices located far away from those specific hubs often start their search with a considerably thinner local base of experienced professionals, even before accounting for how many of those specific professionals have already moved into remote roles with employers located elsewhere entirely.

A rural practice or a small clinic in an area without any strong local training pipeline nearby faces a particularly difficult version of this exact same shortage, since it’s competing simultaneously against several nearby practices for that same thin local pool and against remote employers spread out nationwide who can offer the same candidates far more flexibility without ever requiring any relocation at all. This geographic reality is a real part of why the same national shortage statistics can describe a genuinely different lived experience depending on exactly where a specific practice happens to be located, and why a one-size-fits-all hiring strategy rarely performs as well as one built around the specific regional talent landscape a practice is actually operating within.

What This Means for Healthcare Staffing Strategy

• Build remote flexibility into the search from the start rather than treating it as a fallback. Given how thoroughly remote work has reshaped the candidate pool for these roles, an employer willing to hire remotely from the first day of a search accesses a fundamentally larger pool than one that only considers remote candidates after an on-site search has already stalled.
• Treat CPC-Apprentice candidates as a real pipeline rather than a lesser option. Since the 2-year experience requirement for full certification creates a genuine bottleneck, employers willing to hire and mentor apprentice-level coders can build their own internal pipeline of fully qualified staff rather than competing exclusively for the smaller pool of already-experienced candidates everyone else is chasing too.
• Budget hiring timelines around healthcare’s real averages, not general expectations. With billing roles commonly taking 6 to 12 weeks to fill and healthcare overall averaging well above the general industry standard, planning around a realistic timeline helps avoid the kind of scramble that leads to rushed, poorly vetted hires in a role where genuine mistakes carry real financial consequences.
• Address retention alongside hiring, given how tight the labor market has become. With close to 40% annual turnover in front-office and billing roles specifically, staffing teams need a broader healthcare recruitment and retention approach rather than treating each vacancy as an isolated search, since filling a role without addressing why the previous person actually left tends to produce only a short-lived fix rather than a genuinely lasting solution to the underlying staffing gap that’s sitting there beneath it.

FAQs

Why do medical coders rank as the hardest healthcare role to hire compared with billers or schedulers?
A March 2023 MGMA Stat poll found 34% of medical group leaders cited coders as their hardest revenue cycle role to fill, compared with 26% for billers and 18% for schedulers. The gap comes down to required preparation: coding demands a formal, credentialed certification that takes months to earn, while billing and scheduling roles draw on a wider pool of transferable administrative skills.

What certification do most employers look for when hiring a medical coder?
The Certified Professional Coder credential, offered by the American Academy of Professional Coders, is the most widely recognized standard. Earning it requires passing a multiple-choice exam covering CPT, ICD-10-CM and HCPCS Level II coding systems, and candidates without 2 years of relevant experience receive an apprentice-level designation rather than the full credential.

How much longer does it take to fill a healthcare role compared with other industries? According to a 2023 industry survey, healthcare roles average 49 days to fill compared with a 36-day average across all US industries combined into 1 national figure. Billing roles specifically often run even longer than that, commonly taking 6 to 12 weeks due to the limited pool of candidates who combine solid billing knowledge with genuine healthcare-specific system experience across platforms.

How has remote work affected hiring for medical billing and coding roles?
Remote work turned what used to be a local hiring competition into a national one, since a qualified coder or biller working remotely can now accept a position with any practice or billing company in the country rather than only those within commuting distance. This benefits employers open to remote hiring by widening their candidate pool, while making on-site-only positions harder to fill as local candidates get recruited away by remote opportunities elsewhere.

What does an unfilled billing or coding position actually cost a practice?
Beyond the visible cost of the vacancy itself, an unfilled billing role means denied claims go unworked within their appeal window, and industry data shows accounts receivable aged past 90 days at many practices sits above 35%, a point where collection rates fall off sharply. Since roughly 90% of claims are ultimately payable if worked properly, an extended vacancy directly threatens revenue that would otherwise have been recoverable.

Is the medical coding shortage expected to improve or worsen in the coming years? Federal labor projections suggest the gap will widen rather than close on its own, with demand for coders expected to grow roughly 7% between 2021 and 2031, requiring an estimated 12,300 additional coders beyond current staffing levels. Combined with an aging population driving more claims volume and no major structural change to the certification pipeline, the supply-demand gap is likely to persist without deliberate intervention from individual employers and training programs.

Why can’t billing and coding roles simply be filled with general administrative hires?
The work involves real compliance judgment rather than straightforward data entry, since a coder has to interpret clinical documentation and apply the correct combination of codes in a way that directly affects whether a claim gets paid or denied. Coding and billing rules also change on a regular cycle, which is why credentialing bodies require ongoing continuing education to maintain certification rather than treating it as a 1-time qualification.

What can employers do to shorten time-to-fill for these specific roles?
Building remote flexibility into a search from the outset, treating CPC-Apprentice candidates as a genuine pipeline rather than a lesser substitute, and budgeting realistic timelines based on healthcare’s actual averages rather than general hiring expectations all help. Addressing the underlying turnover driving repeat vacancies matters just as much, since filling a role without addressing why the previous person left tends to produce only a temporary fix.