Health Insurance Specialist

Knowing how to file an appeal with the insurance carrier is important in resolving denied claims. It takes patience as most all insurance companies have different processes, requirements, and timeframes for the appeal process. It’s not always straightforward for a reason.

Just about every practice has some outstanding unpaid claims (A/R or Accounts Receivable) or patient balances. May have a significant amount of money “stranded” and waiting for claim issues to be resolved. If you have experience resolving unpaid claims and reducing A/R this is a huge plus. These type of questions are not uncommon as one of the top interview questions because so many practices struggle with unpaid claims.

The use of medical records software - also referred to to as EMR or EHR software - is increasingly important to providers. They may want the biller and/or coder to enter and maintain information in the EMR system. Employers value someone who is proficient in electronic medical records software and know how to use it. It can also be a valuable asset to the biller and coder in their job when verifying patient information and treatments for a claim. Many billing and practice management software programs are increasingly integrated or interface with the EMR system.

This is a specific one, and the question itself will be tailored toward you and the job at stake. The gist of it is: Employers want to know your motivations.

An anecdote is the strongest way to address this question, Lin says. Sharing a personal story connects your human side with your clinical skills.

My father was terribly sick when I was a teenager, and most of my free time was spent in a caregiving role. I admit I surprised myself by how fulfilling I found it. Even though I missed a lot of social events, it instilled in me a drive to provide that level of care to others, which I’ve done throughout my career.

Yes, I always try to stay up to date with the latest software programs so that I can really be an asset to my company and get my job done efficiently. I also work with PowerPoint and several other programs if they’re needed in the office.

Such a question lets your interviewer know that you want to be effective from day one, says career coach Julie, founder of Act Three. It suggests initiative and preparation, which are critical in the employer's hiring decision. The answer should give you "more in-depth knowledge about the tasks and challenges you'll be facing in your first couple of months

Sometimes there are format or compatibility problems when sending claims to a clearinghouse - especially when setting them up. There’s also a lot of paperwork and forms to fill out when you sign up a provider or practice. Most clearinghouses also provide valuable reporting features to help scrub and catch claim errors so they can be corrected before being sent to the insurance company. Being able to use these features and tools and understand them is valuable experience.

Once you’ve learned on practice management or medical billing software program, it’s pretty easy to learn another. Most well written software is fairly intuitive to use. If you’ve only used on software, you might effectively make this point and emphasize your computer skills.

Yes. At my last position when I was working in a group which was focused around one client’s auto claim, it seemed initially like no one could come to an agreement on what the accident should be covered under. One group member claimed that it rested under one policy, another employee claimed that the accident was the client’s fault and should therefore be handled differently, and I had a third option which involved neither of the first two. We sat down and successfully navigated the situation until we all came to a unanimous understanding of the subject. It’s my belief that we got the client the best outcome possible for their troubles.

It takes about two working days at the very maximum.

We had this patient whom we knew to be extremely difficult. She had a cosmetic procedure done and billed it to the agency who denied it. It was quite a horror trying to extract payment from her as she used abusive language and threatened to take us to court. We managed to negotiate payment from her by reasoning with her gently initially and then very sweetly telling her that we will take legal action. She paid three days later.

I have worked with both. It was interesting working with both despite the delays and the paperwork involved. Nonetheless, the experience has taught me much.

Certain specialties have unique coding and billing requirements. For example some mental health specialties have limitations on the number of visits and require pre-authorizations. These have to be monitored so there are no surprises for either the patient or the provider. If you don't have experience in this particular providers specialty, emphasize your experience in billing for other unique specialties and your ability to adapt and understand the unique billing requirements for specialties.

If you are a medical billing specialist, you will eventually deal with an angry patient. A lot of times they don’t understand their insurance coverage and they take their frustrations out on you - the bearer of the bad news. So when they receive a statement, that’s usually when they call the billing department and want to know why they owe something - or why it’s so much. That’s when it’s important for the biller to patiently explain their insurance coverage and if they desire more info to call their insurance company. Questions about dealing with patients are typically one of the top interview questions for billers.

☛ Give me examples of projects tasks you started on your own.

☛ If you were interviewing someone for Health Insurance Specialist position, what traits would you look for?

☛ What's the most important thing you learned in school?

☛ What are the key values of a Health Insurance Specialist? How do you demonstrate these values?

☛ Have you ever had to introduce a policy change to your work group?

☛ How did you handle meeting a tight deadline?

☛ What performance standards do you have for your unit?

☛ What questions do you have for me?

☛ What do you find are the most difficult decisions to make?

☛ How do you define your key team members?

☛ What was your best learning experience?

☛ What are your salary increases?

☛ What personal weakness has caused you the greatest difficulty in school or at work?

☛ Does your Health Insurance Specialist work relate to any experiences or studies you had in college?

☛ What do (did) you not like?

☛ Wouldn't you be better off in a bigger (smaller) organization?

☛ Do you have a geographic preference?

☛ How much money do you need to make?

☛ Which is more important to you, the money or type of job?

☛ Which areas of your work are most often praised?

☛ Do you check your messages while on vacation?