I prioritize denials by filing deadline, dollar value, likelihood of recovery, payer response time, denial age, recurring root cause, and any issue that could affect multiple claims.
How do you prioritize denials in an AR work queue?
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Detailed Answer
A productive denial queue should not be worked only from oldest to newest or highest balance to lowest.
I would consider:
- Appeal or reconsideration deadline
- Claim balance
- Days in AR
- Probability of overturn
- Payer turnaround time
- Volume of similar denials
- Whether resolving one root cause can release many claims
Deadline risk usually comes first because a high-value claim can become unrecoverable if the appeal window expires.
Key Points to Mention
- Protect filing deadlines first.
- Consider balance and recoverability.
- Prioritize systemic issues affecting many claims.
- Use denial age and payer turnaround strategically.
Example Scenario
A $500 claim has three days left to appeal, while a $5,000 claim has 45 days remaining. The smaller claim may require immediate action first because its recovery window is about to close.
Common Mistakes
- Working only by dollar value.
- Ignoring appeal deadlines.
- Failing to identify high-volume root causes.
Interview Tip
Explain your prioritization logic with a deadline example.