In-house biller vs billing company: the real cost on Long Island

A full-time billing clerk on Long Island earns about $59,600 a year on average, according to the New York State Department of Labor (May 2025 survey, wages updated to early 2026). Benefits and payroll taxes add about 46% on top of wages for office staff nationally, which puts one biller near $87,000 a year before software, training or cover for time off. A billing company charges a share of collections instead. Below a certain collections level the company usually costs less; above it, one employee can cost less, as long as one person can carry the work.

This guide walks through each cost with its source, then shows a break-even table you can redo with your own numbers.

What a biller earns on Long Island

The federal survey of wages by occupation (OEWS) is collected in New York by the State Department of Labor, which publishes estimates for its ten labor market regions. The Long Island region is Nassau and Suffolk counties.

Two occupations matter here. Billing and posting clerks prepare and post bills. Medical records specialists is the federal occupation that now includes medical coders.

Source: NYS Department of Labor, Occupational Wages, May 2025 OEWS estimates updated to the first quarter of 2026 with the federal Employment Cost Index. The state notes the update and the “entry” figure (the average of the bottom third of wages) are its own calculations, not official BLS series.

Two things stand out:

• Long Island pays more than the state average for both jobs. Medical records specialists earn about 26% more on Long Island than the statewide mean.
• Billing clerks cover every industry, not only healthcare. An experienced medical biller who also codes, works denials and talks to payers is closer to the second row than the first.

Add benefits and payroll costs

Wages are not the cost of an employee. The Bureau of Labor Statistics measures the rest in its Employer Costs for Employee Compensation survey.

Source: BLS, Employer Costs for Employee Compensation, June 2026.

The 30% figure is a share of total compensation, which is easy to misread. Measured against wages, benefits for office and administrative staff add about 46% ($11.51 ÷ $25.22). Benefits here include paid leave, insurance, retirement and legally required payroll costs such as Social Security and unemployment insurance. These are national averages, not Long Island figures, and a small practice’s real number depends on its health plan.

Example: a Long Island billing clerk paid the regional mean of $59,574, with benefits at the national office-staff ratio, costs about $86,800 a year. A coder-biller at the medical records mean of $87,287 costs about $127,100.

The costs that aren’t salary

These vary too much for a public benchmark. Get a quote for each from your own vendors.

• Practice management or billing software licences for the biller’s seat.
• Clearinghouse fees for sending claims and receiving remittances (835s), often per claim or per provider.
• Eligibility checks if your system charges per check.
• Training and code updates. CPT and payer rules change every January, and someone has to learn them.
• Hiring. Recruiting, the weeks a new biller needs to learn your payers, and the work that waits while the job is open.
• Supervision. The owner or office manager reviewing the biller’s work. Unpaid time is still time.

Cover for time off

A one-person billing department stops when that person is out. New York requires employers with 5 to 99 employees to provide up to 40 hours of paid sick leave a year, and employers with 100 or more to provide up to 56 hours (NY Paid Sick Leave, as of November 2026). Add vacation and holidays, and a biller is out for several weeks a year.

The cost of that leave is already in the benefits figure above. The risk isn’t. Claims keep their filing deadlines while nobody sends them. Plans regulated by New York must allow at least 120 days from the date of service to submit a claim (Ins. Law §3224-a(g)), and plans outside that law can set shorter limits. Our guide to timely filing limits for New York payers has the plan-by-plan detail.

Ask yourself who sends claims, posts payments and answers patient balance calls during a two-week vacation. If the answer is “it waits”, count that in the cost.

Break-even: when does one biller cost less?

The table compares one Long Island billing clerk (about $86,800 a year including benefits, from the example above, before software and clearinghouse costs) with a billing company fee at three example rates. The rates are illustrations, not quotes or market averages. See how billing company fees work for what the percentage applies to.

In this example, the employee costs less from about $1.45M in collections at 6%, $1.74M at 5% and $2.17M at 4%. Three adjustments make the comparison honest:

• Add your software and clearinghouse costs to the employee column. A billing company’s fee usually covers its own clearinghouse; check yours.
• Check capacity. The break-even only holds if one person can do all the work. Volume per biller depends on specialty, payer mix, prior authorizations and how many claims need follow-up, and there is no public standard for it. Past a point you need a second person, and the in-house column doubles.
• Remember the fee grows with you. A percentage that is cheap at $750,000 is a large line at $3M. Some companies lower the rate as collections rise, so ask how the rate changes with size.

Control and visibility

The case for in-house billing is often control rather than cost: you can walk over and ask. That works when the biller is strong, and it hides problems when the biller is struggling, because nobody else is checking.

Whichever way you go, insist on the same things:

• Logins in the practice’s name for the clearinghouse, payer portals and bank, with the biller as a user you can remove.
• A monthly report with collections, denials by reason, and an AR aging report by payer.
• Read access to the claim history so anyone can see what was sent, when, and what came back.
• Written procedures so the work survives a resignation or a contract ending.

If you outsource, ask a company the 12 questions in our vetting guide before you sign.

A split that often works

Some practices keep the front-end work in-house and send out the rest. The front desk checks eligibility, collects copays and keeps demographics clean, because those happen with the patient in the room. Claim submission, payment posting, denials and appeals go to a billing company. This keeps a person in the office who knows the patients, without asking that person to also be a coding and appeals specialist.

If you are weighing Marlow, our services page lists each task and which ones can stay with your team.

Sources

• NYS Department of Labor, Occupational Wages (OEWS, Long Island region)
• NYS Department of Labor, OEWS technical notes
• BLS, Employer Costs for Employee Compensation, June 2026
• New York State, Paid Sick Leave
• New York Insurance Law §3224-a

General information, not advice on a specific claim, contract or legal question. Rules and rates change; check the linked sources for the current version.