Work History No. 6: A 34-year-old health systems worker earning $90k without a college degree

Before we get started, I just wanted to give a shoutout to Lindsey, who passed her CFP exam on Monday! Yay Lindsey!

Celebrating Lindsey’s pursuit of additional professional credentials fits in well with today’s Work History, featuring a 34-year-old woman who did not attend college and has built a successful career in medical billing, and who made six figures before taking a lower-paying role for the stability.

“Networking and earning additional medical certifications have helped me advance my career and gain valuable experience,” she writes. “Those opportunities have opened more doors for me than I ever imagined.”

The power of networking is a topic we’d love to explore more in the future. Let us know in the comments how networking has impacted your career and finances—and any tips you have for improving your skills! And if you’d like to submit your own Work History, you can do so here!

The responses below have been lightly edited.

Age: 34
Location: South Carolina
Job title and industry: Health information management
Career length: 14 years
First salary: $20,000
Current salary: $90,000

Biggest salary drop?
I accepted a pay cut from $115,000 to $80,000 to join a more stable company while my previous employer was in its third round of layoffs in a year. Four months later, my former employer shut down entirely.

Biggest salary jump?
$50,000 to $90,000. I transitioned from a small-town job I’d held for seven years to a remote role with a large corporate healthcare company.

Best salary-related advice you’ve ever received?
Always leave on good terms and don’t sell yourself short.

I don’t have a bachelor’s degree. Although my parents offered to pay for college, they emphasized avoiding debt and pursuing careers that don’t require a degree. While some roles in my field do require advanced education, I’ve found that staying current on certifications, working hard, and building a strong professional network have created excellent opportunities for growth I never expected.

With hindsight, is there anything you would have done differently at any stage in your career/salary journey if you could go back in time?
No. I believe it’s important to trust your instincts and make decisions based on what is best for you at that point in your life. While others have questioned some of my choices or said they would have done things differently, such as earning a bachelor’s degree, staying at the start-up until it folded so I could receive severance pay, or continuing to search instead of accepting a role with a lower salary, I’ve always made the decisions that felt right for me. So far, that approach has served me well.

Do you have a spouse and/or kids? How have they impacted your career journey/pay?
I am child-free by choice and married my partner in 2025. We were dating when I left my third job for my fourth, but we were not living together, so my career decisions and salary negotiations were independent of the relationship. My partner provided general support and advice while I was figuring out my next steps but did not influence my career path.

Are you happy with your current salary?
Yes. While I think anyone would love to make six figures, my current income is more than enough to cover my needs. My partner and I are child-free by choice, and our combined income allows us to travel domestically, take one international trip each year, pay our bills, and maintain the lifestyle we enjoy. We also live below our means, and I purchased a home with a low interest rate before we got married, which has helped us financially.

Are you worried about the effects of AI on your career?
No. I believe, and am managed by those who believe, there will always be a need for human oversight to validate findings generated with AI. While AI can help create materials and presentations, I don’t see it replacing the teaching and relationship-building aspects of my role.

Biggest salary or career regret?
At first, I felt like a failure going from $115,000 to $80,000, but within a year I’d earned a promotion and increased my salary to $90,000. I also live below my means, so I’ve been comfortable at both income levels. On the lower salary, I just travel less internationally and cut back on extras like facials and skin treatments.

Anything else you’d like to expand on or add?
I’m grateful that I’ve always been intentional about living below my means and avoiding unnecessary debt. Throughout my career, my salary has fluctuated, but because I didn’t increase my core expenses every time my income went up, I’ve been able to maintain a comfortable lifestyle at both higher and lower income levels. Keeping my expenses manageable has given me the flexibility to make career decisions based on long-term growth and opportunities rather than feeling tied to a specific salary.

Also, don’t be afraid to turn down a lowball offer if you’re in a position to do so.

Work History

1st job: Medical billing
Starting salary: $20,000 (part-time)
Departing salary: $50,000 (full-time)
Years: 2012 to 2019

I started my first job in 2012, working part-time at a small doctor’s office, earning about $20,000 a year. I went full-time around 2016 and stayed until 2019, leaving at a salary of about $50,000. That job taught me how to negotiate. Even though they had never hired a part-time employee before, I asked for that schedule during my interview so I could pursue other interests.

From then on, I made it a habit to ask for a raise and performance review every year. The raises weren’t huge, but they taught me that the worst answer you can get is no and the importance of documenting your accomplishments throughout the year. When I left, I learned I was the only person in my department who consistently received raises.

2nd job: Consultant at large healthcare company
Starting salary: $80,000
Departing salary: $90,000
Years: 2019 to 2023

A consultant who visited my first office monthly recommended me for a position at her company. I was seeking a more remote role that would expand my skills, and in this position, I audited provider documentation and educated providers on accurate documentation and billing practices.

I started at $80,000 after negotiating up from an initial $76,000 offer and left earning about $90,000. During that time, I earned several certifications—including in medical coding and medical record review—and received annual bonuses averaging $5,000 to $8,000.

This role reinforced for me the value of negotiating your starting salary, leaving on good terms, and building strong professional relationships. In fact, a former coworker from that company connected me with the opportunity that led to my next role.

3rd job: Manager at healthcare start-up
Starting salary: $110,000
Departing salary: $115,000
Years: 2023 to 2024

I negotiated my offer from $105,000 to $110,000. I worked for a healthcare start-up, where I managed a team of medical auditors responsible for reviewing provider documentation and providing education on compliant documentation and billing. This role was a major step forward in my career, giving me the opportunity to lead a team of 15, travel, and develop my management skills.

I was fortunate to work with a supportive group of people who mentored me and helped me grow. I also received a $2,000 bonus during my time there. I left after 18 months, because the start-up was experiencing layoffs and appeared unstable.

4th job: Regulatory analyst at large health system
Starting salary: $80,000
Current salary: $90,000
Years: 2024 to current day

I originally interviewed for my current role three months prior to accepting it and was offered $70,000 and then $75,000 after declining. I ultimately walked away, letting them know $80,000 was the lowest I would accept. Since I was still employed at the time, I had the ability to negotiate while exploring other opportunities. They ultimately came back a month later with the $80,000 offer.

Currently, I develop educational materials and presentations and educate providers and team members. This role has expanded my skill set by requiring in-depth research into payer rules and regulations. Working for a larger organization has also given me opportunities to collaborate across departments, identify where my skills add value, and explore opportunities for growth.

This experience taught me the importance of knowing my worth and not settling for a lowball offer. Although it meant taking a pay cut from $115,000 to $80,000, I had always kept my expenses low and was financially comfortable making that decision. In this role I still work in healthcare, but I don’t have any direct reports. Since joining this company, I’ve earned a promotion and two raises, bringing my current salary to $90,000.

I wouldn’t rule out taking a management role again in the future if the opportunity and fit were right, but I’ve found I really enjoy being an individual contributor, where I can focus on delivering results and making an impact without the day-to-day administrative responsibilities that come with managing people.

Thank you so much! Please comment with kindness!