Medical coder 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.

• Tell candidates they may be the hospital's only coder, coding every kind of record with no coding manager on site, backed by [your outside auditor or coding service].
• Give the posted schedule and setup: [weekday hours], [remote or hybrid work after training, if you offer it], and the productivity and quality goals, reviewed [monthly].
• Say plainly that you want queries, not guesses, and that coding concerns can go to [your compliance officer] without going through the business office.
• Name the checks that come after an offer, and when: [your background check, timed as your state's fair-chance law allows] and the OIG exclusion list, rechecked [monthly] while they work here.

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 · Accurate coding

   A patient came through the ER, spent a night in observation, then was admitted. Walk me through how you approach coding that stay.

   Patient status changes which guidelines and code sets apply, so this shows whether the candidate checks status before anything else.

   Follow-ups

   • What do you check first, and where in the record?
   • How do you handle a diagnosis the provider calls "probable"?
   • How would you find out which parts of the stay go on which claim here?

   5Strong

   Confirms status and dates from the order and the record first. Applies the inpatient guidelines to the inpatient stay and the outpatient rules to the ER and observation, including how each treats uncertain diagnoses. Uses ICD-10-PCS only for the inpatient procedures. Checks your billing rules for how the stays combine.

   3Mixed

   Knows the inpatient and outpatient rules differ and applies them correctly, but takes the status from the face sheet without checking the order.

   1Weak

   Codes the whole stay one way, or codes a "probable" diagnosis as confirmed on the ER visit.

2. Technical · Compliant queries

   The progress notes show a low sodium level, fluids given for it and daily rechecks, but no provider ever names a diagnosis. Walk me through the query you'd write.

   Writing a query shows more than talking about one: whether the candidate cites the record and leaves the answer to the provider.

   Follow-ups

   • Which facts do you include, and how do you cite them?
   • What answer choices, if any, do you offer?
   • What would make this query leading?

   5Strong

   Quotes the relevant facts and where each appears, then asks openly or offers only clinically supported choices plus "other" and, where it fits, "clinically undetermined". Never mentions payment or quality scores, and never uses yes/no to get a new diagnosis. Codes only what the provider documents.

   3Mixed

   Writes a fair, non-leading question with the right facts, but doesn't say where in the record each fact came from.

   1Weak

   Asks a yes/no question naming the diagnosis, offers only the option that pays more, or codes it without asking.

3. Situational · Compliant queries

   A provider answers your query "unable to determine." The business office manager asks you to send it again, or to another provider, until you get a diagnosis. What do you do?

   It tests whether the candidate knows a fair answer stands, and can say so to their own manager.

   Follow-ups

   • What do you say to the manager, in your own words?
   • When would a new query be fair?
   • Where does this go if the manager insists?

   5Strong

   Codes from the record with the answer given. Explains that the AHIMA and ACDIS guidance calls resending a query until you get the answer you want non-compliant. Would query again only on new clinical facts, and sends any review through the written escalation policy. Takes it to compliance if pressed.

   3Mixed

   Declines to resend and codes it correctly, but can't explain the rule behind it beyond "it doesn't feel right".

   1Weak

   Sends it again, or goes to a different provider to get the answer the manager wants.

4. Situational · Compliant queries

   A locum ER provider who leaves on [Friday] has [six] of your queries still open, and those claims can't go out until they're answered. What do you do?

   With a small, changing medical staff, a query that waits may never be answered, so this shows how the candidate works your escalation policy.

   Follow-ups

   • How do you reach the provider before they leave?
   • Who do you escalate to, and when?
   • What do you never do while you wait?

   5Strong

   Reaches the provider today in the way they prefer and offers to walk through the queries. Records any verbal query as policy says, and codes from it only after the provider documents the answer in the chart. Escalates unanswered ones to [your physician advisor] on time, and tracks the holds.

   3Mixed

   Follows up and escalates as the policy says, but waits until the last day, so some charts are still on hold after the provider leaves.

   1Weak

   Codes from what the provider probably meant, or lets the claims sit without telling anyone.

5. Behavioral · Coding integrity

   Tell me about a time a provider, manager or payer pushed you toward a code the record didn't support. What did you do?

   Every coder gets this pressure. You want one who holds the line and leaves a record.

   Follow-ups

   • What exactly were you asked to do?
   • Who did you go to?
   • What happened afterward, with that person and that claim?

   5Strong

   Explained the guideline calmly, offered a compliant path such as a query, put the disagreement in writing, and took it to a manager or compliance when the pressure continued. Coded what the record supported.

   3Mixed

   Coded what the record supported and explained why, but kept no written record of the request.

   1Weak

   Went along to avoid conflict, or coded it the requested way "just this once".

6. Situational · Coding integrity

   While coding a readmission, you notice the first stay, which you coded and which is already paid, has a diagnosis the record doesn't support. What do you do?

   Owning a mistake on a paid claim is the real test of integrity, and if it caused an overpayment, Medicare sets a deadline to report and return it.

   Follow-ups

   • Who hears about it from you, and when?
   • What else would you check?
   • What would you do if your manager said to let it go?

   5Strong

   Tells [the compliance officer or manager] the same day, in writing, and offers to check their other charts for the same error. Knows compliance decides whether it's an overpayment to report and return by Medicare's deadline (42 CFR 401.305). Changes the habit that caused it.

   3Mixed

   Reports it to the manager promptly and helps correct the claim, but doesn't think to check other charts for the same mistake.

   1Weak

   Leaves it because it's paid, or corrects the claim quietly without telling anyone.

7. Situational · Edits and denials

   The edit report flags an ER visit level and a wound repair on the same claim as services that shouldn't both be billed. Walk me through how you clear it.

   A modifier added just to clear an edit bills for something the record may not support, so this shows whether the candidate reads the record first.

   Follow-ups

   • What in the record would support billing both?
   • What do you do if it doesn't?
   • When do you tell the ER manager?

   5Strong

   Opens the ER record and looks for a significant evaluation documented separately from the repair. Uses the modifier only when that's there; otherwise drops the visit level. Notes the reason on the account, and tells the ER manager if visit-level criteria or charges keep causing it.

   3Mixed

   Reads the record and makes the right call, but leaves no note on the account saying why, and doesn't look at whether other ER claims hit the same edit.

   1Weak

   Adds the modifier because the edit report says it will clear the claim.

8. Behavioral · Edits and denials

   Tell me about a pattern of denials or edits you traced back to its cause. What was it, and what changed?

   Clearing one denial at a time is busywork. The coder who finds the cause saves months of rework.

   Follow-ups

   • How did you spot the pattern?
   • Who did you work with to fix it?
   • How did you know it was fixed?

   5Strong

   Names the denial, how they found the pattern in the data, the cause (a charge setup, a note template, a misread guideline), who fixed it, and how the numbers changed afterward.

   3Mixed

   Found the pattern and its cause and passed it on, but never checked whether the fix worked.

   1Weak

   Works denials one at a time and has never looked for a pattern.

9. Behavioral · Accurate coding

   Tell me about an audit finding on your own coding. What was the error, and what do you do differently now?

   Every coder gets findings. The ones you want check the guideline and change a habit.

   Follow-ups

   • Did you agree with the finding at first?
   • How did you check who was right?
   • What reference or habit did you change?

   5Strong

   Names the specific error, checked the official guidelines or Coding Clinic, owned it, and changed a habit or reference. When they disagreed, disputed it with the guideline, not opinion.

   3Mixed

   Accepted the finding and corrected the chart, but names only a broad lesson, like "read more carefully".

   1Weak

   Says they never get findings, or disputes the finding from memory without opening the guideline.

10. Situational · Privacy

    The next chart in your coding queue is your neighbor's. A coworker who sees the name on your screen asks you to also look up the neighbor's relative, admitted last week, "just to see how things went." What do you do?

    In a small town the coder will meet charts of people they know, and the answer shows whether they keep their access to what the job needs.

    Follow-ups

    • What do you do before reading any further in the neighbor's chart?
    • What do you tell the coworker, in your own words?
    • Who hears about the coworker's request, and why?

    5Strong

    Stops and follows your policy on records of people they know, such as telling the supervisor so the chart can be reassigned. Won't open the relative's chart: it isn't their work. Reports the coworker's request to the privacy officer as policy says. Reads only what coding needs.

    3Mixed

    Asks for the neighbor's chart to be reassigned and turns the coworker down, but doesn't report the request, so the privacy officer can't follow up.

    1Weak

    Opens the relative's chart, shares anything about either patient, or reads parts of the neighbor's chart that coding doesn't need.

Work exercise: code a made-up chart and write a query

Give finalists a made-up, de-identified ER-to-inpatient record with [three] planted gaps: a condition that was treated but never named, two notes that disagree, and a procedure note missing a detail, such as which side. They get [30] minutes and [your encoder or this year's code books] to code what the record supports, list each gap, and write one compliant query. Score the process and the query here; have [your outside auditor] check the codes against an answer key.

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 did their audit results compare with other coders you've worked with, and how did they take findings?
• Tell me about a time they pushed back on a code someone wanted. How did they handle it?
• What did providers say about their queries, and did any feel steered?
• How did they handle records of people they knew, and would you trust them with remote access to patient records again?

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 did they pay you per chart at your last job?

  AskWe pay [hourly or salary, plus any incentive tied to audited quality]. How does that compare with what you need?

• SkipWill your kids distract you on remote days?

  AskRemote work here requires [a private room, a hospital-managed computer, a secure connection and set hours]. Tell me how you'd set that up.

• SkipHave you ever been arrested or convicted?

  AskSay that after an offer you run [your background check, timed as your state allows] and check the OIG exclusion list. If you use a background check company, the FCRA says to give a separate written notice and get the candidate's signed consent before ordering the report.

Common mistakes when hiring a medical coder

• Rewarding the coder who never queries

  A coder who sends almost no queries may be guessing at what providers meant. Ask how often they query, and read the query they write in the exercise before you call low volume efficient.

• No path around the business office

  The coder reports to the business office manager, who also owns the cash. OIG's compliance guidance calls for nonretaliation policies and at least one way to report concerns anonymously that sits outside business operations. Name that path in the interview and stand behind it.

• Testing with the wrong records

  A candidate who has coded only clinic visits may struggle with inpatient and swing bed stays. Build the exercise from the record types your coder will see most.

Medical coder interview FAQ