Medical Billing Executive Interview Questions

I would verify whether payer enrollment and system activation were completed after credentialing, confirm the effective date, group affiliation, billing and rendering NPIs, tax ID…

Timely filing is the payer's deadline for submitting an initial claim or, in some cases, corrected claims and appeals within a defined period.

I would verify the payer's filing limit, confirm the original submission date, gather proof of timely submission or valid delay circumstances, and use the payer's reconsideration…

An authorization denial occurs when the payer determines that required prior authorization, precertification, notification, or referral requirements were not met for the billed se…

Provider demographic changes should be reported through the payer’s required update process so enrollment, directory, claims, and payment records remain accurate. The team should…

I would first determine whether authorization was actually required, whether one existed, and whether the payer allows retroactive authorization or an appeal based on emergency, m…

A duplicate claim denial occurs when the payer believes the same or substantially similar service has already been submitted or processed.

A medical necessity denial occurs when the payer determines that the billed service does not meet its coverage criteria for being reasonable, necessary, or appropriate for the pat…

I would compare the denied claim with prior claim history to determine whether it is truly duplicate, a valid repeat service, or a corrected claim that was submitted incorrectly.

Credentialing verifies the provider’s qualifications, contracting establishes the business and participation terms with the payer, and enrollment establishes the provider or organ…