RCM Specialist Interview Questions

Before resubmitting a claim that the payer says was never received, I would verify the original submission date, clearinghouse acceptance, payer acknowledgment, payer ID, claim de…

Timely filing is the deadline within which a claim must be submitted to the payer after the date of service or another applicable event. Filing limits can vary because different p…

I would look for proof that the claim was originally submitted within the payer’s filing limit, such as clearinghouse acceptance reports, payer acknowledgments, submission logs, o…

Provider credentialing is the process of verifying a healthcare professional’s qualifications, such as licensure, education, training, work history, and other required credentials…

Revenue Cycle Management, or RCM, is the complete financial process used by healthcare organizations to manage a patient account from the first appointment through final payment o…

Eligibility verification is the process of confirming that a patient’s insurance coverage is active for the date of service and reviewing the benefits that apply to the planned ca…

Denial management is the structured process of identifying, analyzing, correcting, appealing, and preventing claim denials so the practice can recover appropriate reimbursement an…

A prior authorization request typically includes the patient’s insurance details, provider information, requested service or procedure, diagnosis, clinical justification, date or…

Before submitting a medical claim, billing staff should verify that the patient, insurance, provider, service, coding, and claim information are complete and accurate. This includ…

If a required prior authorization was not obtained before the service, I would first verify whether authorization was actually required and whether any exception, retroactive auth…