Revenue cycle 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.

• Show the week as it really runs: [weekday hours], [where they'll work once trained], and the heavier weeks at month-end and when payers change rules.
• Say they may be the only biller for [Medicare, Medicaid, several Medicare Advantage plans and commercial payers], with [your business office manager] as backup.
• Tell them plainly that you'd rather write off a claim than bill a charge the record doesn't support, and that they may take a billing worry straight to [your compliance officer].
• Spell out what an offer brings: [your background check, and a credit check only if you use one and your state allows it], plus an OIG exclusion search before day one and on a [monthly] schedule.

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 · Clean claims

   Walk me through how you work the claim edit queue on a Monday morning, from opening it to releasing claims.

   It shows whether they fix claims at the source and route what isn't theirs, or push claims past edits to clear the queue.

   Follow-ups

   • Which edits do you fix yourself, and which go back to someone else?
   • What do you do when the same edit keeps coming from one department?
   • How do you decide what to work first?

   5Strong

   Sorts by filing deadline and dollars, fixes registration and billing data errors themselves, and sends anything needing a code or charge change to [coding or the department], never changing those alone. Notes every fix and tracks repeat edits back to where they start.

   3Mixed

   Fixes and routes edits correctly and notes the account, but works oldest first without checking deadlines and doesn't notice repeat edits.

   1Weak

   Bypasses or overrides edits to release claims, or changes codes to get them through.

2. Situational · Billing integrity

   A department manager asks you to add a supply charge to last month's claims, saying staff always use it but often forget to chart it. What do you do?

   This is how billing for undocumented services starts: a reasonable-sounding request from someone senior.

   Follow-ups

   • What would change your answer?
   • What do you say to the manager?
   • Who else do you tell?

   5Strong

   Doesn't add it. Explains that a charge needs documentation in that patient's record, follows your late-charge policy only where the record supports it, offers to help fix charge capture going forward, and tells [the business office manager or compliance officer].

   3Mixed

   Declines and explains why, but doesn't help fix the charting gap or tell anyone else about the request.

   1Weak

   Adds the charge because a manager asked, or adds it to the claims that look likely.

3. Technical · Denials, appeals and follow-up

   A commercial plan denies an outpatient MRI for no prior authorization. Walk me through how you work it.

   Many authorization denials can be fixed. Their steps show whether they trace what went wrong or just send it again.

   Follow-ups

   • Where do you look first?
   • When, if ever, does the patient get a bill for it?
   • Who hears about it after?

   5Strong

   Checks the portal for an approval with wrong dates, codes or provider, and sends a corrected claim if so. If there's none, checks whether the plan allows a late approval or appeal, files with records on time, reads the contract before billing the patient, and tells patient access.

   3Mixed

   Works the account well and gets it appealed on time, but never tells patient access what went wrong.

   1Weak

   Writes it off, resubmits it unchanged, or bills the patient.

4. Behavioral · Denials, appeals and follow-up

   Describe a denial you overturned with an appeal you wrote. What did you cite, and what did you attach?

   Winning appeals takes a rule, records and a clear letter. The details show whether they've done it or watched it.

   Follow-ups

   • What was the denial reason, exactly?
   • Where did you find the rule you cited?
   • What did you change so it wouldn't happen again?

   5Strong

   Names the denial reason, the payer policy or Medicare rule they cited and where they found it, the records attached, the deadline they met and the result. Changed something upstream after.

   3Mixed

   Won it by resending the claim with records, but can't say which rule or policy made the case.

   1Weak

   Can't name one, or the claim simply went back in unchanged.

5. Situational · Denials, appeals and follow-up

   Back from a week off, you find two unworked denials: a Medicare claim denied [100] days ago and a Medicare Advantage denial of [three] swing bed days. What do you do first?

   Appeal deadlines differ by payer. Checking each one before filing either decides which money you keep.

   Follow-ups

   • Where does each deadline come from?
   • What do you cite for the swing bed days?
   • What do you do so this doesn't sit again?

   5Strong

   Checks both deadlines before filing either: Medicare's redetermination is due a hundred twenty days after the notice arrives; the plan's is on its notice or in the contract. Files the one due first, cites Medicare's coverage rules for the swing bed days, attaches records, and starts a deadline report.

   3Mixed

   Gets both filed on time with records, but can't say where either deadline comes from or what rule to cite for the swing bed days.

   1Weak

   Resubmits the claims instead of appealing, or lets one lapse.

6. Technical · Critical access billing

   Explain how Medicare's payment to a critical access hospital like ours differs from a large hospital's, and what that changes in your billing.

   A biller who knows the payment basics catches the swing bed and Method II errors that others miss.

   Follow-ups

   • What's different about a swing bed claim?
   • What does the optional method, Method II, add to an outpatient claim?
   • Why do accurate charges and days still matter?

   5Strong

   Medicare pays us on reasonable cost for most services, not fixed per-case rates, and swing bed days aren't paid like a nursing home's. Under Method II, practitioners' professional services go on the hospital claim too. Every claim must still match the record; other payers pay their own rates.

   3Mixed

   Knows the hospital is paid on cost, not fixed rates, but can't say what's different about swing bed or Method II claims.

   1Weak

   Thinks it's billed like any hospital, or doesn't know the term.

7. Situational · Billing integrity

   Working credit balances, you find [six] Medicare accounts paid twice for the same visits over the past [year], and a system setting may have caused more. What do you do?

   Federal rules set a deadline once an overpayment is found. Sitting on a credit balance list can turn into a False Claims Act problem.

   Follow-ups

   • When does the clock start?
   • How do you find out whether there are more?
   • How does the money go back?

   5Strong

   Tells [the business office manager] the same day. Knows the sixty-day clock runs from when it's identified, and a timely, good-faith search for related overpayments can pause it for up to a hundred eighty days. Returns the money through the Medicare contractor's process, gets the setting fixed and keeps notes.

   3Mixed

   Reports it the same day and asks [the business office manager] to have the setting checked for other accounts, but leaves that search to others and can't say when the return deadline runs from.

   1Weak

   Leaves the balances until Medicare asks, or moves them to income or another account.

8. Situational · Patient billing questions

   A patient calls, upset that the price posted on our website for their outpatient MRI is lower than their bill. What do you do?

   Hospitals, critical access ones included, must post their prices. Patients now check, and the call tests both billing knowledge and patience.

   Follow-ups

   • Which posted price applies to this patient?
   • They were self-pay and had a good faith estimate. What changes?
   • What if our posted price is wrong?

   5Strong

   Listens, pulls the account and the posted charges, and explains which applies: cash price, plan rate or gross charge, and what the plan left for them. Fixes real errors, explains the dispute process if a self-pay bill ran well over the estimate, offers assistance, and reports wrong posted prices.

   3Mixed

   Explains the bill kindly and offers a payment plan, but doesn't compare it with the posted price or ask about a good faith estimate.

   1Weak

   Says the website is only an estimate and ends the call.

9. Behavioral · Denials, appeals and follow-up

   Tell me about a claim that sat unpaid for months with no denial. How did you finally get it paid or closed?

   Old accounts with no answer are where money quietly dies. Persistence and good notes get it back.

   Follow-ups

   • What did your notes show when you picked it up?
   • Who did you call, and what did you ask for?
   • What did you change after?

   5Strong

   Found the account on an aging report, checked the claim status in the portal, called with the claim number and logged each reference number, learned the real block, such as a request for records, fixed it, and got paid or closed it properly.

   3Mixed

   Kept calling and got it paid, but the notes were thin and they didn't find out why it stalled.

   1Weak

   Can't name one, or resent the claim every few weeks without calling.

10. Behavioral · Clean claims

    Tell me about a payer rule change that affected claims you billed. Where did you learn of it, and what did you change?

    Payer rules change every year. A biller who reads the bulletins prevents denials instead of learning from them.

    Follow-ups

    • Where do you watch for changes?
    • Who else did you tell?
    • How did you check the next claims paid?

    5Strong

    Found it in a payer bulletin, contractor notice or portal before denials hit, updated the claim edit or checklist, told [patient access or coding] if it touched them, and checked the next claims paid.

    3Mixed

    Adjusted quickly after the first denials came back, and passed the fix to the team.

    1Weak

    Kept billing the old way until the denials piled up, or can't name a change.

Work exercise: scrub four made-up claims and draft an appeal

Give finalists [four] made-up claims with remittances and a short made-up chart for each: one with Medicare billed first though the patient's answers show an employer plan, one denied for no authorization, one paid twice, and one with a charge the chart doesn't show. Add a made-up payer policy excerpt. In [25] minutes they rank the work, write the fix for each, and draft one paragraph of the authorization appeal. 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 did they handle claims or appeals close to a deadline? Did any lapse?
• Describe a billing concern they brought to you or to compliance. What did they do?
• How did registration and coding staff find working with them on denials?
• Would you rehire them, and what would make you hesitate?

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.

• SkipDo you carry a lot of debt? You'd be posting patient payments.

  AskAsk every finalist how they reconciled payment postings at their last job. Credit reports fall under the FCRA: disclose in a document by itself and get written authorization, and before any adverse decision based on it, share the report and a rights summary. Some states restrict credit checks, so read yours.

• SkipYou'd be on a headset all day. Any hearing or wrist problems?

  AskTell every candidate the same thing: this job means phone and keyboard work most of the day. Can you do that, with or without reasonable accommodation?

• SkipWhat were you earning at the last hospital?

  AskThe range for this job is [your range]. Is that in line with what you need?

Common mistakes when hiring a revenue cycle specialist

• Trusting experience over judgment

  Some experienced billers learned to make edits go away. Ask the supply-charge and double-payment questions to everyone, and count them as much as the claim questions.

• Paying for cash collected alone

  A bonus tied only to collections rewards ignoring credit balances and pressing patients who qualify for assistance. If you pay a bonus, tie it to clean claims and compliant refunds too.

• Skipping the exclusion check for office staff

  OIG says Federal health care programs won't pay for administrative work done by an excluded person either. Check the exclusion list before the start date, not just for clinicians.

Revenue cycle specialist interview FAQ