RCM Specialist Interview Questions

A frequency-limit denial occurs when the payer determines that a service was performed more often than allowed under its benefit, medical policy, or coding rules.

Provider revalidation is the periodic renewal and re-screening of an existing enrollment record to confirm that provider information remains accurate and enrollment requirements c…

Before activating a new provider in the billing system, the team should verify the provider’s identifiers, specialty, practice locations, tax and group relationships, payer enroll…

A coding denial occurs when the payer identifies a problem with diagnosis, procedure, modifier, units, sequencing, bundling, or other coded claim information.

I would review the payer’s request carefully, identify every missing item, verify that the documents are current and consistent, and resubmit through the required channel within t…

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 clai…

An RCM team should track denial rate, denial dollars, overturn rate, recovery rate, appeal timeliness, top denial reasons, root causes, payer trends, and repeat-denial patterns.

Delegated credentialing is an arrangement in which a health plan authorizes a qualified organization to perform specified credentialing functions on the plan’s behalf under a form…

Denial prevention is the process of correcting upstream workflow problems before claims are submitted so avoidable denials do not occur.

Primary source verification means confirming a provider’s credential directly with the original issuing source or an accepted authoritative source rather than relying only on a co…