How to Build and Lead a Successful Pediatric Billing Team

Summary of presentation from Emily Floyd from Altus Billing Solutions at the 2025 PMI Conference

Managing a pediatric practice often means juggling a lot—clinical care, patient relations, and, of course, ensuring your revenue cycle runs smoothly. One area that’s surprisingly complex is building and maintaining an effective billing team. Emily Floyd, CEO of Altus Pediatric Billing, recently shared her expertise on how to hire the right billing professional, set clear expectations, and implement accountability measures to drive optimal results while also supporting your team culture. This summary highlights key insights and provides five practical takeaways you can implement today.

1. Why Billing Is Uniquely Challenging for Pediatric Practices
Billing for pediatric healthcare is rife with ever-changing rules, variable payer policies, and unique clinical codes. Unlike clinical or front desk roles, billing jobs can vary drastically from one practice to another, meaning "five years of experience" may not translate directly across jobs. Many practices depend on a single biller, making it difficult to compare performance or mentor newcomers. Billing is also central to cash flow, tempting practices to make hasty hires under pressure. Finally, many owners struggle to clearly define the expectations and responsibilities that underpin billing success.

2. Hiring: Beyond Experience—Find the Right Fit With Core Values
Emily emphasizes that shared core values are just as important as billing skills. A candidate who collects well but clashes with your culture or disregards patient-centered care can undermine your practice's harmony. In interviews, ask questions that prompt candidates to demonstrate empathy, teamwork, curiosity, or accountability—and observe their enthusiasm. For technical skills, prioritize experience with pediatric claims, full revenue cycle management, and familiarity with your EMR, but don’t discount soft skills and core values. The right candidate should not just fill a technical role—they should support your whole practice mission.

3. Setting Up Your Biller for Success With Clear Expectations
Once you’ve hired the right person, set them up for success by clarifying priorities and desired outcomes. While it's tempting to focus on metrics like denial rates and A/R aging, remember that many influencers—like payer quirks or front desk errors—are outside your biller’s control. Instead, look at process: Are routines being followed? Is there regular, proactive claim follow-up? Give new hires at least 90 days focused on insurance billing before gradually layering on additional responsibilities, like patient collections or reporting.

4. Accountability: Tracking Progress With Routines and Validation
To ensure continued high performance, establish routines and regular check-ins. Use a routine checklist that details daily, weekly, monthly, and annual billing tasks. Require your team to submit this checklist regularly, and request simple weekly reports—such as claims sent, payments posted, or aging A/R. Set aside time each month to validate a sample of their work, confirm numbers match your own system reports, and provide direct, constructive feedback. This fosters transparency, builds trust, and catches potential issues early.

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Five Practical Takeaways for Better Billing Team Management

1. Integrate Core Values Into Hiring:
   During interviews, discuss your practice’s core values and ask behavioral questions to see if candidates align with your team’s philosophy.

2. Prioritize Clear Communication and Process over Pure Metrics:
   Develop and share well-defined routines for your biller (daily/weekly/monthly tasks) and prioritize process adherence to ensure consistency.

3. Establish an Accountability System:
   Require regular submission of completed routine checklists and weekly summary reports to keep visibility on key billing processes.

4. Validate Regularly, Trust with Verification:
   Set aside monthly time to randomly audit billing workflows and results, cross-checking reported metrics for accuracy and oversight.

5. Encourage and Reward Positive Performance:
   Provide prompt, specific feedback, recognize successes, and course-correct constructively. Remember: What gets rewarded gets repeated.

By structuring your hiring and management processes around these principles, you can build a pediatric billing team that not only supports your financial health but also strengthens your office culture and patient experience.