Medical billing interview question and answers imp
Explain a time when you had to resolve an error with a claim in the clearinghouse
A clearinghouse is an online portal where medical billers submit claims to insurance payers, and part of this process involves payers scrubbing claims and sending back any with inaccuracies. Use this question to demonstrate your knowledge of the clearinghouse and show how you address these rejections.
Example: “When theres an error with a claim, that means that the payer has found something wrong with the information we provided. My job as a biller is to review the electronic remittance advice, or ERA, that breaks down each element of the claim and the items that theyre denying.
I then compare the information in our electronic health records system, or EHR, making sure the patients name and date of birth are correct, the right amounts are attributed to copay, coinsurance and deductible amounts. I often review physician notes, diagnosis codes and procedure codes to make sure everything is correct.
Whenever I find the errors that initially caused the payer to reject the claim, I make sure to correct the information in the EHR system before resubmitting to the clearinghouse. This ensures our in-house records match the payer records.”
What is your approach to dealing with rejected or unpaid medical claims?
A:
Your medical biller will need to work with a number of claims on a daily basis, some of which will turn out to be rejected or unpaid claims down the line. It is important for your candidate to have a strategy for dealing with these situations in a collected manner and the knowledge to resolve the situation as efficiently as possible. Your organization’s long-term financial health and trustworthiness to the community will be depending on the settlement of these types of difficult-to-settle claims. What to look for in an answer:
“First, I would find out the reason why the claim was rejected or unpaid. Then, I would get in contact with the appropriate organization or individual to work out a solution.”
Q:
Most common medical billing interview questions
When interviewing for medical billing roles, there will be some common ground from job to job, company to company. Here are 10 questions with example answers so you can craft your own effective responses:
How do you follow HIPAA regulations when managing patient accounts?
Every patient must sign a Health Insurance Portability and Accountability Act (HIPAA) form when they see a provider. This form outlines a patients rights to keep their medical records and insurance information private or accessible to other people as necessary. Use this question to highlight your understanding of these regulations and the importance of protecting patients health information.
Example: “When a patient calls regarding their account, I always verify their name, date of birth and account number, if they have it. If a family member or caregiver is calling on behalf of the patient, I ask for the patients information along with the callers name and relationship to the patient. This allows me to check that this person is listed on the patients HIPAA form and I can speak with the caller about the patients account.”
