{
 "id": "healthcare-admin/finance/patient-billing-claims-preparation",
 "title": "Claims and patient billing preparation in healthcare administration",
 "url": "https://costtoautomate.com/healthcare-admin/finance/patient-billing-claims-preparation/",
 "industry": {
  "slug": "healthcare-admin",
  "name": "Healthcare administration",
  "naics": "621 Ambulatory Health Care Services (admin processes only)"
 },
 "function": {
  "slug": "finance",
  "name": "Finance"
 },
 "apqc_pcf_steps": [
  {
   "hierarchy_id": "9.2.2",
   "element_id": "10743",
   "name": "Invoice customer (closest cross-industry match for payer billing)",
   "pcf_version": "7.4 cross-industry"
  },
  {
   "hierarchy_id": "9.2.2.1",
   "element_id": "10794",
   "name": "Maintain customer/product master files",
   "pcf_version": "7.4 cross-industry"
  },
  {
   "hierarchy_id": "9.2.2.2",
   "element_id": "10795",
   "name": "Generate customer billing data",
   "pcf_version": "7.4 cross-industry"
  },
  {
   "hierarchy_id": "9.2.2.3",
   "element_id": "10796",
   "name": "Transmit billing data to customers",
   "pcf_version": "7.4 cross-industry"
  },
  {
   "hierarchy_id": "9.2.2.5",
   "element_id": "10798",
   "name": "Resolve customer billing inquiries",
   "pcf_version": "7.4 cross-industry"
  }
 ],
 "industry_differences": [
  "Billing goes to payers (insurers) as claims as well as to patients, under each payer's rules.",
  "Preparing a claim means checking coding, eligibility and required attachments. Coding itself stays with certified staff.",
  "Denials and resubmissions are a large share of the work."
 ],
 "occupations": [
  {
   "soc": "43-9041",
   "title": "Insurance Claims and Policy Processing Clerks",
   "naics": "621000",
   "hourly_median_usd": 21.67,
   "hourly_mean_usd": 22.31,
   "onet_core_tasks": [
    "Prepare insurance claim forms or related documents, and review them for completeness.",
    "Calculate amount of claim.",
    "Post or attach information to claim file."
   ]
  },
  {
   "soc": "43-6013",
   "title": "Medical Secretaries and Administrative Assistants",
   "naics": "621000",
   "hourly_median_usd": 21.82,
   "hourly_mean_usd": 22.17,
   "onet_core_tasks": [
    "Answer telephones and direct calls to appropriate staff.",
    "Schedule and confirm patient diagnostic appointments, surgeries, or medical consultations.",
    "Complete insurance or other claim forms."
   ]
  }
 ],
 "scenario": {
  "assumptions": {
   "vol": 2000,
   "humanMin": 6,
   "browserMin": 2,
   "sandboxMin": 0,
   "emails": 0,
   "reviewPct": 30,
   "reviewMin": 2
  },
  "assumptions_status": "editorial estimate (not sourced data)",
  "labor_rate_usd_per_hour": 21.67,
  "labor_rate_basis": "BLS OEWS May 2025 hourly median, wages only",
  "model": {
   "id": "sonnet55x",
   "name": "Claude Sonnet 5.5 (XHigh)",
   "cost": 0.48,
   "score": 36.83,
   "src": "Zapier AutomationBench 1.0.6",
   "url": "https://zapier.com/benchmarks"
  },
  "infra_unit_prices": {
   "browser_hr": 0.12,
   "sandbox_hr": 0.1656,
   "email": 0.002
  },
  "result_usd_per_month": {
   "infra_per_task": 0.004,
   "ai_total": 968.0,
   "review_total": 433.4,
   "agent_total": 1401.4,
   "manual_total": 4334.0,
   "difference": 2932.6
  }
 },
 "confidence": "mixed: sourced wages + estimated volumes/times",
 "apqc_cross_check": null,
 "sources_retrieved": "2026-10-16",
 "attribution": {
  "apqc": "APQC’s Process Classification Framework® (PCF) is an open standard developed by APQC, a nonprofit that promotes benchmarking and best practices worldwide. The PCF is intended to facilitate organizational improvement through process management and benchmarking, regardless of industry, size, or geography. To download the full PCF or industry-specific versions of the PCF, as well as associated measures and benchmarking, please visit www.apqc.org/pcf.",
  "onet": "This page includes information from the O*NET 31.0 Database by the U.S. Department of Labor, Employment and Training Administration (USDOL/ETA). Used under the CC BY 4.0 license. O*NET® is a trademark of USDOL/ETA. Cost to Automate has modified all or some of this information (selected Core task statements only; text unchanged). USDOL/ETA has not approved, endorsed, or tested these modifications.",
  "bls": "BLS OEWS May 2025, public domain"
 }
}