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Medical Biller interview questions and how to answer them

A billing manager isn't hiring you to be nice on the phone. They're hiring you to get claims paid the first time and to fix the ones that aren't, without creating a compliance problem along the way. Expect questions that test whether you've actually worked a denial queue or just read about one.

11 questions7 minute read

Part 1

1.Walk me through what happens to a claim from charge entry to payment.

Why they ask

It's the fastest way to tell whether you understand the whole cycle or only the piece you did at your last job.

How to answer

  • Start with eligibility and authorization on the front end, then charge entry with the codes from the coder or provider
  • Describe scrubbing: checking modifiers, diagnosis links and demographics before submission
  • Explain the clearinghouse step and the difference between a rejection and a denial
  • Finish with remittance posting, patient responsibility and follow-up on anything unpaid

2.A payer denied a claim for lack of medical necessity. What do you do?

Why they ask

Medical necessity denials are common and time-consuming, and they show whether you read payer policy or just resubmit and hope.

How to answer

  • Read the denial reason and remark codes on the remittance first
  • Pull the payer's coverage policy for that procedure and compare it to the provider's documentation
  • Check whether the right diagnosis is linked to the line, since that's often the real fix
  • Choose between a corrected claim and a formal appeal with records attached, and track the deadline

3.What's the difference between a rejection and a denial?

Why they ask

People mix these up all the time, and the fix for each is different.

How to answer

  • A rejection never made it into the payer's system, usually because of a data error caught by the clearinghouse or payer front end
  • A denial was processed and the payer decided not to pay
  • Rejections get corrected and resent quickly, while denials may need a corrected claim, reconsideration or appeal
4.How do you decide what to work first when your queue is full?

Why they ask

Every biller has more claims than hours. The manager wants to know you won't just work oldest to newest or easiest first.

How to answer

  • Timely filing and appeal deadlines come first, because missed ones are usually lost money
  • High-dollar claims and whole batches with the same error come next
  • Mention using the aging report and work queues in your system to sort
  • Give a real example of a week when you had to reorder your plan
5.Which practice management and clearinghouse systems have you used?

Why they ask

Training on a new system takes time, and they want to know how much of it you'll need.

How to answer

  • Name the systems plainly, such as Epic, athenahealth, eClinicalWorks, AdvancedMD or Tebra, and the clearinghouse
  • Say what you actually did in each: charge entry, posting, denial work queues, reports
  • If you haven't used theirs, describe how quickly you picked up the last new one

Part 2

6.A patient calls upset about a bill they didn't expect. How do you handle it?

Why they ask

Patient calls are part of the job, and a bad one can turn into a complaint or an unpaid balance.

How to answer

  • Verify identity before discussing anything, because of HIPAA
  • Pull up the remittance and explain deductible, coinsurance or a non-covered service in plain words
  • Check whether the balance is actually right, since sometimes the billing is wrong
  • Offer the options the practice allows, like a payment plan, and note the account clearly
7.You notice a provider keeps billing a higher-level visit than the notes seem to support. What would you do?

Why they ask

This is a compliance question. They want to see that you'd raise it without accusing anyone or quietly changing codes yourself.

How to answer

  • Don't change codes on your own, since that's the coder's or provider's call
  • Document what you're seeing with specific claims
  • Bring it to your billing manager or the compliance contact, following office policy
  • Say why it matters: overbilling can trigger audits and paybacks
8.How do you post a payment when the insurer paid less than you expected?

Why they ask

Posting mistakes hide underpayments and bill patients for the wrong amount.

How to answer

  • Compare the allowed amount to the contracted rate or fee schedule
  • Post the contractual adjustment correctly and move the true patient share to the patient
  • If it's underpaid against the contract, flag it and send it back for reprocessing
  • Mention watching for the same underpayment across many claims
9.Tell me about a time you found a mistake that was costing the practice money.

Why they ask

Good billers notice patterns. This question separates people who work claims from people who fix the reason claims fail.

How to answer

  • Set up the situation: what kept getting denied or underpaid
  • Explain how you traced it back, like a registration error or a missing modifier
  • Describe the fix you pushed for and who you worked with
  • Say what changed afterward, in words rather than invented figures
10.How do you keep up when payer rules change?

Why they ask

Payers update policies, forms and portals often, and a biller working from old rules sends bad claims.

How to answer

  • Name real sources: payer bulletins and provider portals, your clearinghouse's edits, AAPC or AMBA material if you're certified
  • Describe how you share changes with the team, such as a running notes file or a quick huddle
  • Give one example of a rule change you caught and adjusted to

Part 3

11.Why do you want to work in medical billing rather than another office job?

Why they ask

Turnover in billing is real. They want someone who knows what the work feels like and still wants it.

How to answer

  • Be honest about what you like, such as solving a denial or knowing the rules well
  • Show you understand the hard parts, like hold times and repeated follow-up
  • Connect it to where you want to grow, such as denial management or coding

Questions to ask them

Ask at least two. It shows you're picking them too.

  • Which payers cause the most denials here, and what's usually behind them?
  • Will I own the full cycle for certain providers, or one piece like posting or denials?
  • How is productivity measured, and who reviews my work while I'm learning your system?
  • Do billing and coding sit together, and how do I send a question back to a coder?
  • What does the aging report look like right now, and what would you want me to tackle first?

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