In-House Medical Biller Cost by State: What One Employee Costs, Fully Loaded

Billing and posting clerks (SOC 43-3021) cost an employer more than the wage BLS reports. The employer pays benefits and legally required payroll costs on top of that wage. A MedPrecision ratio of 1.3123, built from June 2026 ECEC figures ($36.73 total compensation per hour worked ÷ $27.99 in wages plus paid leave), converts an annual wage into that loaded cost.

The in-house medical biller cost by state shows a loaded-cost gap of $41,300 a year between West Virginia and the District of Columbia for the same occupation. The DC annual mean wage is 1.75 times the West Virginia annual mean wage, a MedPrecision calculation.

The five highest-paying areas for 43-3021 in May 2025 (the District of Columbia and four states), by annual mean wage:

1. District of Columbia: $73,360
2. California: $58,180
3. Massachusetts: $57,160
4. Minnesota: $56,640
5. Connecticut: $56,570

The five with the lowest were Louisiana ($44,310), Mississippi ($42,770), Alabama ($42,280), Arkansas ($42,020) and West Virginia ($41,880).

In May 2025, billing and posting clerks (SOC 43-3021) earned an annual mean wage of $51,070 nationally across all industries (BLS OEWS, read 23 October 2026). State means ran from $41,880 in West Virginia to $73,360 in the District of Columbia.

One billing and posting clerk paid the US all-industry annual mean wage costs an employer about $67,000 a year fully loaded. By state, this MedPrecision calculation from BLS OEWS May 2025 wages and ECEC June 2026 benefit costs runs from $55,000 in West Virginia to $96,300 in the District of Columbia.

Every loaded cost on this page counts paid leave once. An annual wage already pays for leave, so the ratio adds only the other benefits and legally required costs; the method section shows why the 1.43 to 1.46 shortcut overstates the cost.

These figures answer one question: what one employee costs your practice. Whether outsourcing beats an in-house team is a separate decision, and our comparison of outsourced and in-house medical billing works through it.

Find your state's row below. Each row shows the BLS annual mean wage for two occupations and the fully loaded cost MedPrecision calculates from it. The loaded cost equals the annual mean wage x $36.73 ÷ $27.99 (1.3123 rounded), rounded to the nearest $100, for both occupations. The 29-2072 columns use the same office and administrative support ratio as the 43-3021 columns, so the two compare directly; the method section gives the alternative ratio. Wages are May 2025 OEWS estimates for all industries in each state; OEWS excludes the self-employed.

The downloadable CSV adds employment and the annual median wage for every row, plus the BLS series ID behind each figure. BLS did not release the Vermont employment estimate for SOC 29-2072, so that cell reads "suppressed"; the Vermont wage figures are published.

One medical records specialist (SOC 29-2072, which includes medical coders) paid the US all-industry annual mean wage of $56,790 costs an employer about $74,500 a year fully loaded. By state, that MedPrecision calculation runs from $58,200 in Mississippi to $105,300 in the District of Columbia.

BLS classifies the person who prepares bills and the person who assigns codes in two different occupations. The 2018 Standard Occupational Classification defines SOC 43-3021 Billing and Posting Clerks as workers who compile and record billing data and prepare billing invoices, for services or for shipments of goods. That definition is not specific to healthcare, and it states that it excludes Medical Records Specialists (29-2072). SOC 29-2072 Medical Records Specialists covers workers who compile and maintain medical records and classify diagnoses, procedures and services into the industry's numerical coding system. Its definition states that it includes medical coders.

That split changes the number you budget. Pick the row that matches the job you are hiring for:

• A billing hire (claims, invoices, recording billing data): use the 43-3021 columns. The US annual mean wage is $51,070 and the median is $48,500.
• A coding hire (assigning diagnosis and procedure codes): use the 29-2072 columns, which also cover medical records work. The US annual mean wage is $56,790 and the median is $51,140.
• One person doing both: the two rows for your state frame the cost; the 29-2072 annual mean is the higher of the two in every state and DC.

Pay inside one occupation also varies. Nationally, the 10th percentile annual wage for 43-3021 was $37,290 and the 90th percentile was $67,710. For 29-2072 the 10th and 90th percentiles were $37,000 and $81,150. BLS counted 404,060 billing and posting clerk jobs and 194,720 medical records specialist jobs in May 2025.

Medical records specialists (SOC 29-2072, which includes medical coders) earned a higher May 2025 annual mean wage than billing and posting clerks (SOC 43-3021) in all 50 states and DC. The US gap was $5,720 (BLS OEWS; MedPrecision calculation).

MedPrecision calculates every loaded cost on this page in four steps:

1. Take the wage. BLS reports the OEWS May 2025 annual mean wage for the state and occupation. OEWS calculates an annual wage as the hourly wage x a work year of 2,080 hours, and OEWS wages are straight-time gross pay without premium pay such as overtime.
2. Take the benefit costs. BLS ECEC Table 4 for June 2026 reports that private-industry employers paid office and administrative support workers $36.73 per hour worked in total compensation: $25.22 in wages and salaries and $11.51 in benefits, of which $2.77 was paid leave.
3. Build the ratio for a salary. ECEC counts costs per hour worked and lists paid leave as a benefit, while an annual wage already pays for leave hours. So the ratio divides total compensation by wages plus paid leave: $36.73 ÷ ($25.22 + $2.77) = 1.3123 (MedPrecision calculation).
4. Apply it. The loaded cost equals the annual mean wage x $36.73 ÷ $27.99, rounded to the nearest $100. For the US 43-3021 mean of $51,070, that gives $67,000.

Why the 1.43 to 1.46 shortcut overstates the cost

One shortcut divides total compensation by wages alone: $36.73 ÷ $25.22 = 1.4564 for office and administrative support workers, or $46.89 ÷ $32.82 = 1.4287 for all private-industry workers (MedPrecision calculations). That ratio fits a cost per hour worked. Applied to an annual wage, it counts paid leave twice: the annual wage already pays for the leave hours, and the ratio adds paid leave again as a benefit. On the US 43-3021 mean it gives $74,400, which is $7,400 above the salary-basis figure (MedPrecision calculation).

On a salary basis the result lands close to adding the benefit share to the wage: $51,070 plus 31.3% is about $67,100, against $67,000 from the ratio (MedPrecision calculation). Inside the 31.3% benefit share, paid leave made up 7.5% of total compensation, legally required benefits 7.0% and insurance 11.0%, for private-industry office and administrative support workers in June 2026.

Which ECEC group the ratio comes from

MedPrecision uses the office and administrative support group because billing and posting clerks sit in that major occupation group. The 29-2072 columns use the same ratio so the two occupations compare directly. SOC 29-2072 itself sits in major group 29, Healthcare Practitioners and Technical Occupations. Other June 2026 groups in the same ECEC Table 4 give these salary-basis ratios (private industry, per hour worked):

The health care and social assistance row is the closer industry match for a practice, and it raises the US 43-3021 figure by $400. The professional and related row lowers the US 29-2072 figure by $2,000.

To model your own payroll, software and turnover numbers instead of a state average, run them through the billing cost calculator.

To set one employee's loaded cost beside a vendor fee quoted as a percentage of collections, the arithmetic below puts one 43-3021 employee's loaded cost on that same scale. It is arithmetic only: it is not a staffing level, and this page states no number of billing employees for any practice size. Each share uses the rounded loaded cost.

One billing and posting clerk at the US all-industry annual mean wage, fully loaded, equals 6.7% of $1M in annual collections. The same cost equals 3.4% of $2M and 1.3% of $5M (MedPrecision calculation; arithmetic only, not a staffing level).

A full in-house billing function adds costs this table leaves out, such as software, clearinghouse, supervision, recruiting and training. To set this payroll line beside a vendor price, read what billing companies charge as a percentage of collections, and see what an outsourced billing team takes off your payroll for the scope of the work.

Read date: every figure on this page was read on 23 October 2026.

Sources:

• Wages: BLS Occupational Employment and Wage Statistics (OEWS), May 2025 estimates, released 15 May 2026 (USDL-26-0725; www.bls.gov/news.release/archives/ocwage_05152026.htm), the newest OEWS release on the read date. Values were pulled series by series through the BLS Public Data API v1; each CSV row carries its series ID, and the same series can be checked at data.bls.gov/timeseries/ followed by the ID.
• Benefit load: BLS Employer Costs for Employee Compensation (ECEC), June 2026, Table 4, released 9 September 2026 (USDL-26-1494): www.bls.gov/news.release/archives/ecec_09092026.htm
• Cost basis: BLS ECEC Technical Note, which states that ECEC measures costs per hour worked and lists paid leave as a benefit. Archive capture: web.archive.org/web/20260819191634/https://www.bls.gov/news.release/ecec.tn.htm
• Occupation definitions: BLS, 2018 Standard Occupational Classification, major groups and detailed definitions. Archive capture: web.archive.org/web/20261016075115/https://www.bls.gov/soc/2018/major_groups.htm

Method: the loaded cost equals the OEWS annual mean wage x $36.73 ÷ ($25.22 + $2.77), that is ECEC total compensation divided by wages and salaries plus paid leave, per hour worked, for private-industry office and administrative support occupations (1.3123 rounded), rounded to the nearest $100, for both occupations. All shares, gaps and alternative ratios are MedPrecision calculations from those figures.

What these figures leave out:

1. Industry mix. Wages are all-industry state means, and 43-3021 is a general billing occupation that also covers billing for goods. Nationally, the 65,230 billing and posting clerks in Offices of Physicians (NAICS 621100) averaged $49,390, below the all-industry $51,070; the 34,860 medical records specialists there averaged $50,060, below the all-industry $56,790.
2. One national load. MedPrecision applies one national ECEC ratio, for office and administrative support workers, to every state and to both occupations; benefit costs in a given state or for 29-2072 can differ from it.
3. Salary basis. The ratio treats the annual wage as already paying for leave hours, so it adds paid leave once. It applies the office and administrative support average for paid leave to both occupations.
4. Different periods. The wages are from May 2025 and the benefit load is from June 2026; no wage-growth adjustment is applied.
5. Only wages and benefits. The loaded cost covers wages plus employer-paid benefits and legally required costs. It excludes software, recruiting, training, office space and supervision.
6. Not a staffing model. One employee's cost does not tell you how many employees your practice needs, and this page does not estimate it.
7. Self-employed and suppressed cells. OEWS excludes the self-employed. BLS did not release the Vermont employment estimate for SOC 29-2072; it is shown as suppressed and is not estimated.

Next updates: BLS schedules the next ECEC release (September 2026 data) for 16 December 2026. From the December 2026 data, ECEC will remove workers' compensation costs (announced in the June 2026 release). The OEWS figures will change with the next OEWS release.

What other pages publish: in a search on 23 October 2026 we found no ranking page that publishes an employer's fully loaded cost per state, or that sets SOC 43-3021 beside SOC 29-2072 with BLS's own exclusion language. State wage tables for 29-2072 do exist, mostly written for job-seekers.