Home health billing specialist interview questions

What this hire must get done

Write the scorecard before you interview, then hire against it. Set the bracketed targets from your own numbers.

What to tell candidates before the interview

Say the hard parts plainly. People who wouldn't stay drop out early, and the ones who stay knew what they signed up for.

• Lay out the week: [weekday hours], [your office, hybrid or remote policy], and the hard days right before payroll and each claim cutoff.
• Say they'll bill Medicare home health, [your Medicaid programs], Medicare Advantage plans, long-term care insurance and families paying privately, often all in one week.
• Tell them they'll chase nurses, therapists and physician offices for signatures and notes every day, and that a claim waits until the paperwork is right.
• Cover the screening: [your background check] once an offer is made, within your state's timing rules, and searches of the OIG and [your state's Medicaid] exclusion lists at hire and [monthly] after that.

How to run the interview

1. Same questions, same order. Ask every candidate the questions below and the same follow-ups. It is the only way to compare people fairly.
2. Two interviewers. An owner or manager and someone who does the work. Take notes on what the candidate says, not on how you feel about them.
3. Score right after each answer. 5 sounds like the strong answer, 3 like the mixed one, 1 like the weak one. Use 2 and 4 for answers in between.
4. Rate alone, then compare. Compare candidates question by question, and talk only after everyone has scored. Big gaps are worth a conversation.

1. Technical · Medicare home health claims

   Tell me what a Medicare Notice of Admission has to wait for, and what a late one costs the agency.

   Since 2022, a late notice cuts the period's payment for every late day, and the agency can't bill the patient for those days.

   Follow-ups

   • How do you know you haven't missed a new admission?
   • What counts as an exception?
   • How often does one notice need to be filed for the same patient?

   5Strong

   Needs the first visit's orders documented and that visit made. Files within five calendar days of the start of care, once per admission. Each late day cuts a thirtieth of the period's payment, never billable to the patient. CMS waives that only for events beyond the agency's control.

   3Mixed

   Knows the five-day deadline and checks admissions daily, but can't say what must happen first or what a late notice costs.

   1Weak

   Doesn't know the Notice of Admission, or thinks the patient can be billed for the late days.

2. Technical · Medicare home health claims

   A final claim comes back from Medicare because no matching OASIS was found. Walk me through how you fix it.

   Medicare sets the payment group from the OASIS, so a claim that can't match one won't pay. The fix shows real home health experience.

   Follow-ups

   • What do you check on the OASIS validation report?
   • Which fields have to match on the claim and the assessment?
   • What do you do if the patient's Medicare number changed?

   5Strong

   Checks the validation report that the assessment was accepted before the claim went, and resends if the claim went first. Matches the agency number, Medicare number and completion date on both, corrects whichever is wrong, and leaves clinical answers to clinicians. Calls the Medicare contractor only if it still returns.

   3Mixed

   Knows to confirm the OASIS was accepted and to resend, but can't name the fields that must match.

   1Weak

   Resends it unchanged again and again, or edits the payment code to get it through.

3. Situational · Clearing billing holds

   Payroll is Friday. A large batch of Medicare visits can't bill because [four] plans of care and [six] verbal orders are still unsigned by the physicians or allowed practitioners. What do you do?

   Medicare bars the final claim until the plan of care and later orders are signed. The pressure is to bill anyway.

   Follow-ups

   • What goes out today, and what waits?
   • Who chases the signing offices, and how?
   • What do you tell the CFO, and when?

   5Strong

   Holds those claims and bills everything else that's clean. Sorts the unsigned items by dollars and age, works with [the clinical manager] to reach each signing office, and tells the CFO today what's held, how much, and when it should clear.

   3Mixed

   Holds the claims and chases the signatures well, but tells the CFO on Friday morning instead of when the problem showed up.

   1Weak

   Sends the claims before the signatures come back, or waits for someone else to chase them.

4. Situational · Medicaid, EVV and authorizations

   A Medicaid personal care visit is on the schedule and in the caregiver's note, but the EVV record has no clock-out. The claim is due tomorrow. What do you do?

   Federal law has each state check Medicaid home care visits electronically, and typing in times is the easy shortcut. The answer shows whether they correct a record the way your state allows.

   Follow-ups

   • What does your state require to correct a visit record?
   • Who confirms the visit really happened?
   • What do you do about why it was missed?

   5Strong

   Doesn't bill it as is. Follows [your state's EVV correction rules], such as a reason and the caregiver's and client's confirmation, so the record matches the claim. Holds the claim if the visit can't be proven, and tells [the scheduler] so the caregiver gets help with the app.

   3Mixed

   Holds the claim and asks the scheduler to get the visit confirmed, but doesn't know what proof the state requires or look at why it was missed.

   1Weak

   Types in the scheduled times to close the gap, or bills without a matching EVV record.

5. Situational · Medicaid, EVV and authorizations

   Therapy visits for a Medicare Advantage patient have gone on for [two] weeks past the number the plan approved. What do you do?

   Visits past an approval often go unpaid. How they respond shows whether they fix the money and the tracking, or push the cost onto the patient.

   Follow-ups

   • What does the plan allow after the fact?
   • Who do you tell today?
   • Could the patient owe anything for those visits?

   5Strong

   Tells [intake, the scheduler and the clinical manager] today so a new approval is sought before more visits. Asks the plan about a late approval or appeal and sends records. Knows an in-network agency can't bill the patient beyond cost-sharing for its missed approval. Adds end-date and visit-count alerts.

   3Mixed

   Requests the approval and tells intake, but doesn't change how approvals are tracked, so it can happen again.

   1Weak

   Bills the patient, writes it off without trying, or bills the visits under the old approval.

6. Technical · Denials and records requests

   Walk me through answering a Medicare additional documentation request for a home health claim.

   Records requests are where home health claims are won or lost. Missing a signature or the deadline turns a paid claim into a denial.

   Follow-ups

   • What's in the packet?
   • What do you check before it goes?
   • A nurse offers to add a note now. What do you say?

   5Strong

   Logs it the day it arrives with its due date. Gathers the certification, face-to-face note, signed plan of care, every order, the OASIS, and visit notes showing homebound status and skilled need. Checks signatures and dates, sends it complete, tracks the result, and never has records changed to fit.

   3Mixed

   Pulls the right records and sends them on time, but doesn't review them for missing signatures or dates first.

   1Weak

   Sends the chart unreviewed, misses the due date, or asks a clinician to fill in notes after the fact.

7. Situational · Billing integrity

   In a monthly audit you find [four] paid Medicare periods that list aide visits with no visit note and no clock-in record. What do you do?

   Once an agency identifies an overpayment, federal rules generally give it sixty days to report and pay it back. This tests whether they act on it or bury it.

   Follow-ups

   • Where would you look for proof the visits happened?
   • When does the deadline start?
   • How do you check whether other claims have the same problem?

   5Strong

   Raises it with the CFO or [your compliance officer] that day and looks for proof, never writing notes now. If there's none, adjusts the claims to drop those visits, returns any overpayment through the Medicare contractor within the sixty-day rule, and checks other claims for the same cause.

   3Mixed

   Tells the CFO right away, looks for proof and corrects those [four] claims, but leaves the search of other claims to the CFO and doesn't know when the sixty days begin.

   1Weak

   Leaves it alone because the claims were paid, or asks aides to write the notes now.

8. Behavioral · Private-pay invoicing

   Tell me about a time a client or family disputed an invoice. How did you sort it out?

   Private-pay families compare every invoice with what they saw. Handling disputes with records keeps the client and the cash.

   Follow-ups

   • What records did you pull?
   • What did you say to the family?
   • What did you change after?

   5Strong

   Pulled the visit notes, clock-in records and service agreement, went through it line by line with the family, credited real errors quickly, explained the charges that were right, offered a payment plan where it helped, and fixed the cause.

   3Mixed

   Kept the family happy with a credit, but didn't check the records first to see whether the invoice was wrong.

   1Weak

   Argued, or sent it to collections without reviewing it.

9. Behavioral · Clearing billing holds

   Describe a stretch when clinicians or doctors' offices were slow to send you signatures or notes you needed. What did you do?

   The specialist depends on busy clinicians every day. You want firm, polite follow-up, not silence or blame.

   Follow-ups

   • How did you ask the first time?
   • What did you do when it still didn't come?
   • How did you keep the working relationship good?

   5Strong

   Asked clearly for what was missing, why it mattered and by when, followed up on a fixed rhythm, went to [the clinical manager] politely when needed, and kept a good working relationship.

   3Mixed

   Kept asking until it came in, but sent the same request each time and never said what was at stake or went up a level.

   1Weak

   Waited, or complained about them without following up.

10. Behavioral · Billing integrity

    Tell me about a time someone asked you to bill something you weren't sure was allowed. What did you do?

    Billers get pressure from owners, nurses and families. How they pushed back before shows how they'll push back here.

    Follow-ups

    • Where did you look to find the rule?
    • What did you say to the person who asked?
    • How did it end?

    5Strong

    Paused the claim, checked the rule and the record, explained the answer plainly to the person who asked, and took it to [the CFO or compliance officer] if they pushed. Can say how it ended.

    3Mixed

    Didn't bill it and said why, but never found the actual rule or told anyone above them.

    1Weak

    Billed it because someone senior asked, or says it's never come up and can't say what they'd do.

Work exercise: sort six made-up billing holds

Hand finalists a made-up hold report with [six] items: a Notice of Admission not yet filed for a start of care [four] days ago, a final claim waiting on a signed plan of care, a Medicaid visit missing its EVV clock-out, a Medicare Advantage patient past the approved visits, a records request received [30] days ago, and a private-pay invoice listing a visit with no clock-in. In [25] minutes they set the order and name who does what next. No real patient information.

Use made-up materials, never real customer work, and keep it to the time shown. Follow your own safety rules for anything hands-on.

Reference check questions

Tell finalists you'll call a former manager, and get their permission first. Ask about what they did, not whether they were nice.

• How current did they keep the billing hold report and Notices of Admission?
• How did nurses and therapists respond when they chased missing paperwork?
• Tell me about a billing error they found that cost the agency money to fix. What did they do?
• Would you hire them back into billing?

Questions to skip, and what to ask instead

Ask only what the job needs. Questions that touch age, health, family or pay history can break federal, state or local law, even when you mean well.

• SkipWhat was your hourly rate at the last agency?

  AskThe job pays [your range]. What rate do you need?

• SkipWho'll watch your kids on days you come into the office?

  AskThe schedule is [your office days and hours, and your remote policy]. Can you work that schedule?

• SkipAnything on your record I'll find when I check?

  AskSay that [your background check] runs after a conditional offer where your state requires that, with written consent, and that every hire is searched on the OIG and [your state's Medicaid] exclusion lists.

Common mistakes when hiring a home health billing specialist

• Expecting a clinic or hospital biller to know home health

  Notices of Admission, period billing and OASIS matching don't exist in a doctor's office. Ask the two Medicare technical questions to everyone, and plan training if the answers are thin.

• Letting billing fix the clinical record

  When cash is short, pressure builds to tidy notes so claims pass. Tell candidates up front that corrections belong to the clinician who did the visit, and listen for anyone who sees it differently.

• Testing only Medicare skills

  Much of your income may come from Medicaid waivers, long-term care insurers and private-pay families. Ask the EVV and invoice questions too, or you'll find the gaps at month-end.

Home health billing specialist interview FAQ