The resignation letter lands and two clocks start: the two-week notice, and the quieter one — claims aging toward deadlines, denials accumulating unworked, and knowledge preparing to walk out the door. Practices that treat week one as triage protect months of revenue; practices that treat it as a hiring problem discover the difference in their spring cash flow.
Days 1–3: Capture What’s Leaving
Access inventory first. Every portal login, clearinghouse credential, and payer account your biller uses — documented, tested, and transferred to practice-controlled credentials before the last day. Orphaned logins are the classic post-departure discovery, usually made while a claim burns.
Knowledge download, structured. Not “write down what you do” — specific prompts: which payers need what quirks, where the follow-up lists live, what is currently in progress, which claims are near deadlines, who the payer-rep contacts are. Two focused hours of structured questions beat a vague handover document.
Deadline sweep. Appeals with windows closing, timely-filing risks in the rejection queues, authorization renewals due — the items where two weeks of drift becomes permanent loss. These get worked or explicitly scheduled before anything else.
Days 4–7: Establish Coverage
Someone must own the daily minimum — charge entry, submission, rejection work, posting — even imperfectly, because the pipeline compounds its backlogs fast. Options in speed order: internal reassignment (with realistic scope), temporary contract help, or an outsourced team starting on defined scope. The math favors deciding fast: every uncovered week converts directly into aged AR that costs more to recover than coverage would have cost to maintain.
The Structural Question
Then the real decision — rebuild the single-biller model, or change the architecture? Worth answering with data rather than reflex: what did the last transition cost in measurable revenue dip, what does the local hiring market actually offer, and what does the full comparison look like? Our in-house versus outsourced comparison lays out the honest framework; some practices should rebuild in-house, and the analysis will say so.
What no practice should do is what most do: rush-hire under cash-flow pressure into the same single-point-of-failure design, and schedule the next crisis for whenever that person resigns.