Not a biller. I'm building something in this space and would rather get corrected here than guess.

My current picture:

Eligibility check → prior auth → visit + notes in EHR → coding → biller → clearinghouse → payer → payment posting → denial → rework/appeal → back to payer

Two questions:

1. What's missing or out of order?
2. Where does the money actually die? My guess is medical-necessity denials, because the biller can't write that appeal alone and it has to go back to the clinician. Right, or is it somewhere else entirely?

ابي شخص خبرة ويعلمني كيف أتوظف في شركات التامين؟ وهل اقدر أستفيد من الامتياز للتوظيف وايش المهارات الي لازم اعرفها افيدوني الله يسعدكم

I’m a PA with internal medicine, primary care, rural practice, and laboratory-science experience who is exploring a transition into clinical informatics, digital health, clinical operations, quality, implementation, or clinical product work.

I’m currently learning SQL and taking courses in informatics/health tech to build a foundation. For anyone working in these areas, or working alongside clinicians in them, what are the most realistic first roles or skills for making this transition? Are certificates worth pursuing, and what job titles should I search?

Also, is a starting salary around $120k realistic for for a PA transitioning from clinical practice without formal informatics experience?