The medical coding and billing industry is under pressure from multiple directions in 2026. Payer-imposed prior authorization requirements, evolving ICD-10-CM and CPT coding guidelines, and denial rates that the Healthcare Financial Management Association (HFMA) estimates have climbed to an average of 10 to 15 percent of submitted claims are squeezing billing company margins and straining staff bandwidth. In response, forward-thinking billing companies are integrating virtual assistants into their operational workflows to handle the high-volume, time-sensitive tasks that don't require a certified coder's expertise.
The Denial Management Burden
Denial management has become one of the most resource-intensive functions in medical billing operations. When a claim is denied, billing staff must identify the denial reason code, gather supporting documentation, draft an appeal or corrected claim, re-submit, and track the outcome — a process that can take 30 minutes or more per claim. With denial volumes running into the hundreds or thousands per month at mid-sized billing companies, the aggregate labor cost is enormous.
Many of the tasks in the denial cycle are administrative rather than clinical. Identifying which claims in the accounts receivable (AR) work queue have aged past 30 or 60 days, calling payer provider service lines to obtain claim status updates, logging call outcomes, and routing unresolved denials to the appeals team are all functions that a well-trained virtual assistant can handle effectively.
MGMA data shows that practices using outsourced billing services see an average first-pass claim acceptance rate of 94 percent when billing companies deploy structured follow-up workflows — and VAs are increasingly part of that structure.
Claim Status Tracking at Scale
For billing companies managing hundreds of provider clients, real-time claim status visibility is critical. Virtual assistants can work through payer portal queues or conduct direct outreach to payer provider service lines to obtain status updates on pending claims, documenting outcomes in the practice management system and flagging claims that require escalation.
This function is particularly valuable for smaller payers that lack automated eligibility and claim status response capabilities, requiring manual inquiry by phone or portal login. Rather than pulling a certified biller away from coding or appeals work to make routine status calls, billing companies can assign this function to a VA operating from a structured daily workflow.
Provider Communication and Client Relations
Billing companies also face ongoing communication demands from their provider clients. Physicians, practice managers, and office administrators routinely request status updates on outstanding claims, explanations for specific denial codes, and clarification on payment posting questions. Managing this inbox is time-consuming but does not require deep billing expertise for the majority of inquiries.
Virtual assistants trained on a billing company's standard communication templates can handle routine provider inquiries, escalating complex questions to a senior biller while ensuring that every client request receives an acknowledgment and a realistic resolution timeline. This kind of responsive communication is a key driver of client satisfaction and retention in the competitive billing services market.
Supporting Coder Productivity
Beyond the billing workflow itself, virtual assistants can support the coders and billers at a billing company with administrative tasks — managing incoming documentation from provider offices, following up on missing records needed to complete claims, scheduling coding team meetings, and maintaining productivity tracking dashboards. These functions reduce interruptions to coding staff and help maintain throughput during high-volume periods.
Medical coding and billing companies looking to build out virtual assistant support for their operations can explore dedicated revenue cycle VA services through Stealth Agents, which provides trained healthcare administrative VAs experienced in billing workflow support.
As payer complexity continues to grow and provider clients demand faster turnaround, billing companies that invest in scalable administrative support infrastructure will be better positioned to protect margins and grow client relationships.
Sources
- HFMA. "Revenue Cycle Benchmarking Report 2025." hfma.org
- MGMA. "Medical Practice Billing Efficiency and Outsourcing Trends 2025." mgma.com
- CMS. "Medicare Claims Processing Manual." cms.gov