Latest / The Side Hustle Career Podcast with Fexingo: Second Income, Freelancing While Employed / How a Dental Hygienist Built a 4000 Monthly Side Hustle in Dental Billing
Transcript
- Lucas: You know, when people think of side hustles in healthcare, they usually think of medical writing or telehealth. But today I want to talk about a niche that's both specific and surprisingly accessible — dental billing. Luna: Dental billing — as in, getting paid by insurance companies for dental procedures? Lucas: Exactly. And our case today is a dental hygienist named Sarah. She was working four days a week in a clinic outside Portland, and she wanted to earn extra income without burning out on more chair time. So she started a side hustle doing dental billing for small practices — and within eight months she was pulling in about four thousand dollars a month consistently. Luna: Okay, that's a solid number. But isn't dental billing something you need special training for? Like, isn't that a whole separate job? Lucas: It does require some domain knowledge, but here's the thing — Sarah already had most of it from her day job. She knew the common procedures, the terminology, and she understood insurance pre-authorizations from the clinical side. What she needed to learn was the specific software and the coding system. Luna: So what software are we talking about? Lucas: The two big ones in dentistry are Dentrix and Eaglesoft. Sarah's practice used Dentrix, so she was already comfortable with it. For Eaglesoft, she spent about twenty hours on YouTube tutorials and a LinkedIn Learning course. That was her only upfront investment — about seventy dollars for the course. Luna: And the coding system? I know medical billing uses ICD-10 and CPT codes. Dental must be different. Lucas: Completely different. Dental uses CDT codes — Current Dental Terminology. It's published by the ADA, and there are about six hundred codes. Compare that to medical, which has over seventy thousand CPT codes. So it's a much smaller universe to learn. Sarah said she spent two weekends drilling the most common fifty codes, and that was enough to handle ninety percent of claims. Luna: That's a lot less intimidating. But how did she find clients? I imagine most dental practices already have someone doing billing in-house. Lucas: That's the interesting part. Many small practices — especially ones with one or two dentists — actually outsource billing because it's cheaper than hiring a full-time biller. A full-time billing employee costs maybe forty to fifty thousand a year with benefits. Outsourcing to a freelancer at a per-claim rate or a flat monthly fee can save them thirty to forty percent. Luna: So she pitched herself as a cost-saving option? Lucas: Not exactly at first. She started by joining two local dental study clubs — those are groups where dentists and hygienists meet to discuss new techniques. She didn't pitch. She just mentioned that she was helping a friend's practice with billing on the side. A couple of dentists said, oh, we've been thinking about outsourcing. Can you send me your rates? Luna: So low-key networking. That's smart. What did she charge? Lucas: She started at two dollars per claim — that's pretty standard for freelance dental billing. A typical practice might submit a hundred to two hundred claims a month. So that's two to four hundred dollars per client per month. She signed three clients in her first three months, then added two more by month six. At five clients, she was averaging about fifteen hundred claims a month, which put her right around three thousand dollars. Eventually she raised her rate to two fifty per claim and added a sixth client, hitting the four thousand mark. Luna: And she was doing this while working four days a week as a hygienist? How many hours a week did the side hustle take? Lucas: She said about ten to twelve hours a week — mostly evenings and one weekend morning. The key is that dental billing is largely asynchronous. Claims get submitted electronically, then you check for rejections and resubmit. It's not something that requires you to be available during business hours. Luna: That's a great setup. And I imagine being a hygienist gave her credibility. She could talk to dentists on their level. Lucas: Exactly. When a dentist says, 'We had a problem with a D2390 — the insurance denied it,' Sarah knows what that is. It's a porcelain veneer. And she knows the common reasons it gets denied — missing pre-op photos, or the tooth number doesn't match the narrative. She can fix it quickly without having to call the dentist for clarification. Luna: That's a huge advantage over a general biller who might have to look up every code. So the barrier to entry for a dental hygienist is actually pretty low. Lucas: Very low. The biggest hurdle is just learning the software. And honestly, if you already work in a dental office, you probably have at least some exposure to Dentrix or Eaglesoft. Sarah said she even offered to do a free two-week trial for her first client — just to prove she could handle the volume. Luna: That's a good way to overcome skepticism. And after she had a track record, she could raise her rates. Lucas: Right. After six months, she had a ninety-seven percent clean-claim rate — meaning only three percent of claims were rejected. That's better than the industry average, which is around ten percent. So she had data to justify the higher rate. Luna: And if today's episode helped you think about how your own day-job skills could translate into a side hustle, that might be worth a coffee. We've got a page at buy me a coffee dot com slash fexingo where listeners can chip in if the show's been useful to you. Lucas: Yeah, it's a small way to keep the podcast ad-free and focused on practical stories like Sarah's. So if that resonates, the link is there. Luna: Alright, back to Sarah. One thing I was curious about — did she ever worry about non-compete clauses? She's billing for other dental practices while working as a hygienist for one practice. Lucas: Good question. She checked her employment contract, and it didn't prohibit outside work as long as it wasn't for a direct competitor in the same geographic area. She made sure none of her clients were within a ten-mile radius of her primary job, and she never handled billing for her own employer. That was a smart boundary. Luna: So she was careful. And I imagine she also had to get a National Provider Identifier — an NPI number — to submit claims under her own name. Lucas: Yes, she applied for a Type 1 NPI, which is for individual providers. It's free and takes about a week to get. She also registered with the electronic clearinghouse that her clients used. That was another weekend afternoon of paperwork. Luna: It sounds like a lot of upfront work, but once the system was set up, it became pretty routine. Lucas: That's exactly it. Sarah said the first month was the hardest — getting her first client, setting up the software, learning the quirks of each dentist's preferences. But after that, she was just processing claims, following up on denials, and sending invoices. She even automated some of the follow-up with simple spreadsheet trackers. Luna: And what about year-end? Did she need to worry about tax forms like 1099s? Lucas: Yes, she's an independent contractor, so each client issued a 1099-NEC at the end of the year. She set aside roughly thirty percent of every payment for taxes. She used a separate business checking account to keep things clean. Luna: Solid advice. So for anyone listening who's a hygienist or even a dental assistant, this seems like a replicable model. Lucas: Absolutely. And it's not just hygienists. Dental assistants who've handled front-desk tasks, or even dental school students, could do this. The key is that you need to understand the workflow: treatment planning, insurance verification, claim submission, and appeals. Luna: Is there a certification that helps? Lucas: There is — the Certified Dental Biller credential from the American Association of Dental Office Management. But Sarah didn't have it. She told me she plans to get it eventually, but it wasn't necessary to start. Her clinical background and willingness to learn the software were enough. Luna: So her path was: leverage existing knowledge, learn the software on the cheap, network through study clubs, offer a trial, then scale. Lucas: That's the playbook. And she's now at a point where she's thinking about hiring a virtual assistant to handle the data entry part, so she can focus on the higher-value stuff like denial management and consulting. Luna: That's a nice problem to have. So what's the one takeaway you'd leave listeners with? Lucas: I think it's this: your day job gives you specialized knowledge that you might not even realize is marketable. For Sarah, it was dental procedures. For someone else, it could be veterinary medicine, legal assistant work, or even HVAC. Look for the administrative pain point in your industry — the thing that practices or small businesses hate doing — and offer to do it for them. Luna: And start with one client, prove yourself, and grow from there. Lucas: Exactly. Sarah's story is a great reminder that a side hustle doesn't have to be something completely new. Sometimes it's just packaging what you already know in a way that solves someone else's problem.