This page is for people interviewing for medical billing, AR caller and denial management roles on insurance claims. Expect a few questions on why you want the work and how you feel about night shifts, then checks on the revenue cycle, claim forms, denial codes, payer types and appeals. Many interviews also run a short mock call where the interviewer plays the insurance rep. Each question shows what the interviewer is listening for, a shape for your answer and a sample you could say out loud. Coding questions sit on the medical coder page.
Search all questions by round, difficulty and level, or save the ones you want to practise.
Path: the short version, such as your studies, a course or a first job.
What you learned: what the job really is, calling payers to get unpaid claims paid.
Why it fits: a strength of yours that suits the work.
"After my degree I did a short course on the healthcare revenue cycle because a friend in the field kept talking about how much problem-solving was involved. What stuck with me is that every unpaid claim has a reason, and the AR caller's job is to find it and clear it. I like that. It's not just talking on the phone, it's reading an EOB, understanding the denial, and then getting the payer to act. I'm patient on the phone, I'm careful with details, and I don't mind repeating a process until it's right. Those three things seem to matter most in this job, so AR calling felt like a natural fit for me."
Describing the job as a plain voice process with no mention of claims, denials or payers.
Honest yes: say clearly that you can work nights.
Your routine: sleep, meals and how you get to work.
Support: family or home setup that makes it work.
"Yes, I can work nights, and I've thought about it properly rather than just saying yes. I've done a night shift before during a short support job, so I know the first two weeks are the hardest. What worked for me was a fixed sleep window, blackout curtains, and eating a proper meal before the shift instead of snacking all night. My family knows my schedule, so the daytime stays quiet at home. I also keep the same sleep time on my days off as much as I can, because switching back and forth is what really wears people down. I'd rather plan for it than hope it works out."
A quick yes with no plan, or hinting you will ask for a day shift soon after joining.
Skill: billing needs knowledge of claims, payers and rules.
Impact: your calls bring real money into a clinic or hospital.
Growth: where the path leads, such as denials, QA or team lead.
"In a general support job, most calls are someone else's problem coming to you. In AR, I'm the one making the call with a clear goal: get this claim paid or find out exactly why it isn't. That needs real knowledge of claim forms, denial codes, payer rules and appeals, and I like building that kind of expertise. It also matters to me that the work has an effect. A clinic can't pay its staff if its claims sit unpaid for months. And there's a clear path to grow, from AR calling into denial analysis, quality or leading a team, so it feels like a career I can build on rather than just a job."
Saying you just want any job with calls, or that billing is easier than support.
Front end: scheduling, registration, eligibility and authorization.
Middle: charge entry, coding and claim submission through a clearinghouse.
Back end: payment posting, AR follow-up, denials, appeals and patient billing.
"It starts before the visit. The front desk registers the patient, captures the insurance details, checks eligibility, and gets prior authorization if the service needs it. After the visit, the services are coded and the charges are entered. The claim goes out, usually electronically through a clearinghouse, which checks it for errors before sending it to the payer. The payer adjudicates it and sends back an ERA or EOB, and the payment gets posted. Anything unpaid or denied lands in AR, where people like me follow up, fix and resubmit, or appeal. Whatever the patient owes is billed to them. The account closes when the balance is zero, either through payment or an approved adjustment. Most denials I'd work trace back to the front end, which is why those first steps matter so much."
Starting the cycle at claim submission and ignoring registration, eligibility and authorization.
Speed: days in AR and the share of AR older than 90 days.
Quality: clean claim rate, first-pass resolution and denial rate by reason.
Outcome: net collection rate, meaning collected against what could be collected.
"The first one I'd look at is days in AR, which is total AR divided by average daily charges. It tells you roughly how long it takes to get paid. Next is how much of the AR is older than 90 days, because old AR gets harder to collect the longer it sits. For quality, the clean claim rate and the first-pass resolution rate show whether claims are right the first time. The denial rate matters too, but I'd always break it down by reason and payer, because one total number doesn't tell you what to fix. Finally, the net collection rate compares what we collected with what we could have collected after contractual adjustments. If that's slipping while days in AR looks fine, money is being written off that shouldn't be."
Naming only calls per day or claims touched, which measure effort, not results.
CMS-1500: professional claims from physicians and other practitioners; electronic version is the 837P.
UB-04: institutional claims from hospitals and facilities; electronic version is the 837I.
Why it matters: different fields and rules to check when you work the claim.
"The CMS-1500 is the professional claim form. Physicians, therapists, group practices and suppliers use it to bill for their own services, and its electronic version is the 837P. The UB-04, also called the CMS-1450, is the institutional form. Hospitals, skilled nursing facilities, home health agencies and similar facilities use it, and electronically it's the 837I. The UB-04 carries things the 1500 doesn't, like revenue codes and a type of bill code that says what kind of facility claim it is. So when I'm working a denial, the first thing I check is which kind of claim it was, because the fields that went wrong and the way to correct them are different."
Mixing up which form goes with facilities and which with physicians.
Rejection: stopped at the front door by clearinghouse or payer edits, never adjudicated.
Denial: processed by the payer, with a claim number and reason codes.
Fix: correct and resend a rejection; correct, reconsider or appeal a denial.
"A rejection means the claim never got into the payer's processing. The clearinghouse or the payer's front-end edits stopped it, usually for something like an invalid member ID, a missing NPI or a formatting problem. There's no claim number and no EOB. I fix the error and send it again as a new claim, and I do it fast, because a rejected claim usually doesn't count as received for timely filing. A denial is different. The payer accepted the claim, processed it, and decided not to pay, so there's a claim number and reason codes on the remittance. If I just resend it as a new claim, I'll get a duplicate denial. Instead I send a corrected claim if our data was wrong, or ask for reconsideration or file an appeal if the payer's decision was wrong."
Treating the two words as the same thing, or resubmitting denied claims as brand new claims.
Group code: who is responsible: CO, PR, OA or PI.
CARC: the reason for the adjustment, such as 45 for charges above the allowed amount.
RARC: extra detail, codes starting with M, MA or N.
"The two letters are the group code, and they tell me who carries the amount. CO is contractual obligation, meaning the provider writes it off and can't bill the patient. PR is patient responsibility, like deductible, coinsurance or copay. OA is other adjustments, and PI is a payer-initiated reduction. The number is the Claim Adjustment Reason Code, which says why. CARC 45 means the charge was more than the fee schedule or contracted amount, so CO-45 is usually just the normal contractual write-off, not a real problem. The remark code, the RARC, adds detail the CARC can't, and it starts with M, MA or N. I always read them together, because the same CARC with a different remark code can point to a very different fix. The lists are updated regularly, so I check the current version when a code is unfamiliar."
Treating every CO-45 as a denial to appeal, or not knowing what the group code means.
Denial: the code and what it looked like at first.
Digging: how you found the real cause.
Result: the fix, the payment and what you learned.
"At my last company I had a claim denied because the payer said the patient had other coverage that should be primary. The patient said they only had one plan. I called the payer and learned their records still showed a spouse's employer plan that had ended months earlier. So the payer wasn't wrong to ask, it just had old data. I called the patient, explained that only they could update the coordination of benefits with their insurer, and walked them through the call. I set a follow-up for a week later, confirmed the update, and asked the payer to reprocess. It paid within the next cycle. I also found three more claims for the same patient with the same denial and got all of them reprocessed on one call."
A story where you just resubmitted the claim and it happened to pay.
Pattern: what you saw and how often.
Cause: where in the cycle it started.
Fix and proof: what changed and how you knew it worked.
"In my last role I kept getting authorization denials on imaging claims for one payer, several a week. When I pulled a month of them, almost all were scans booked at one location, and the payer had recently added those scans to its prior authorization list. The front desk there didn't know. I shared the list of affected claims with my team lead and the front desk supervisor, along with the payer's policy update. They added an authorization check to the booking step for that payer. For the claims already denied, we asked for retro authorization where the payer allowed it and appealed the rest. Over the next two months those denials dropped to almost none. I learned that pulling a small report is often worth more than fixing claims one by one."
Only describing how fast you reworked each claim, with no attempt to find or fix the source.
Dates: date of service, the payer's limit and our first submission date.
Proof: clearinghouse acceptance reports, payer acknowledgements, earlier denials from another payer.
Outcome: appeal with proof, or a write-off under policy, and never a bill to the patient.
"First I'd check the dates: the date of service, this payer's filing limit, and when we first sent the claim. Limits vary a lot. Original Medicare allows one calendar year from the date of service, while commercial plans set theirs in the contract. Then I'd look for proof. The clearinghouse acceptance report showing the payer accepted the claim in time is the strongest. I'd also check whether we billed the wrong payer first, since some payers accept that as proof, and for a secondary claim whether the limit counts from the primary's payment date. If I find proof, I file a reconsideration or appeal with it attached. If there's truly none, it's a write-off under our policy with approval. Either way I note the root cause, and the patient is never billed for it."
Writing it off straight away, or moving the balance to the patient.
Confirm: the termination date against the date of service, with the rep or on the portal.
Find coverage: updated insurance from registration or the patient, and eligibility checks on likely payers.
Act: bill the right payer within its filing limit; patient billing only if there was truly no coverage.
"First I'd confirm the facts, because payers sometimes have the wrong dates. I'd compare the termination date they show with the date of service, and ask whether the patient moved to a different plan with the same payer, since a new member ID can look like a lapse. If the coverage really ended, I'd look for the new insurance. I'd check registration for an updated card, run eligibility checks on the likely payers, and if nothing turns up, get the patient contacted for their new details. When I find active coverage, I update the account and bill that payer quickly, because its filing clock is already running. Only if the patient truly had no coverage that day would the balance move to them, under our self-pay policy. I'd also let the front desk know, since an eligibility check at the visit should have caught it."
Moving the full balance to the patient without checking for other coverage.
Identifiers: patient, payer claim number, date of service, check or EFT number.
Amounts: billed, allowed, paid, adjustments and patient responsibility.
Codes: group, reason and remark codes that explain every gap.
"An EOB is the paper or PDF version, and the ERA is the electronic one, the 835 file, that usually posts automatically. Either way I look at the same things. First the identifiers: the patient, the payer's claim number, the date of service, and the check or EFT number so I can match it to the deposit. Then the amounts line by line: what we billed, what the payer allowed, what they paid, what they adjusted off, and what they've assigned to the patient as deductible, coinsurance or copay. Then the codes. Every gap between billed and paid should have a group code and a reason code explaining it. If the paid amount plus adjustments plus patient responsibility doesn't add up to the billed amount, something's wrong and I dig in before posting."
Looking only at the paid amount and ignoring the reason codes and patient responsibility.
Billed: the provider's full charge, same for every payer.
Allowed: what the payer's contract or fee schedule accepts for the service.
Split: the allowed amount is shared between payer and patient; the rest is written off.
"The billed charge is the provider's standard price, and it's usually the same no matter who the payer is. The allowed amount is what the payer agrees the service is worth under the contract or fee schedule. The gap between billed and allowed is the contractual adjustment, and for an in-network provider it's written off, not billed to the patient. The allowed amount is then split. The patient's share is whatever falls to them as deductible, coinsurance or copay, and the payer pays the rest. So a quick check I do is that the payer's payment plus the patient's share equals the allowed amount, and the allowed amount plus the write-off equals the billed charge. If those don't balance, there's an error somewhere, either in posting or in how the payer processed it."
Saying the patient owes whatever the payer didn't pay, including the contractual write-off.
Confirm: compare the allowed amount with the contracted rate for that service and date.
Rule out: valid reductions such as multiple procedure rules, modifiers or patient share.
Recover: reprocessing request, then a payment dispute or appeal, and flag patterns.
"First I'd make sure it really is an underpayment. I'd compare the allowed amount on the remittance with the contracted rate for that service on that date, since fee schedules change. Then I'd rule out valid reasons for a lower payment, like a multiple procedure reduction, a modifier that reduces payment, or part of the amount being assigned to the patient. If it's still short, I'd call the payer, point to the rate, and ask them to reprocess. If they won't, I'd file a payment dispute or appeal with the relevant part of the contract attached. I'd never just write the difference off as contractual without checking. And if I see the same payer underpaying the same service on several claims, I'd raise it with my lead, because it's probably a loading error on their side."
Posting the payment and writing off the difference as a normal contractual adjustment.
Confirm: same patient, date, service and claim, and not two valid lines.
Report: flag it to the credit balance or refunds team under policy.
Resolve: refund or agreed recoupment, fully noted, within the payer's deadlines.
"First I'd confirm it's really a duplicate. I'd check that both payments are for the same patient, date of service and procedure, and not two separate services, or a payment and a later adjustment that nets out. I'd also check the payer hasn't already started taking it back from a future payment. If it's a true overpayment, I wouldn't move the money to another balance or leave it sitting there. I'd flag it to whoever handles credit balances and refunds under our policy, with the claim numbers and both EOBs. Government programs like Medicare have strict deadlines for returning overpayments once they're identified, and commercial contracts often set their own. Then the payer is either refunded or allowed to recoup, and the account is noted so nobody gets confused later."
Leaving the credit on the account or applying it to another claim without authorization.
Medicare: a federal program; claims go to a regional contractor under national rules.
Medicaid: run by each state within federal rules, often through managed care plans; payer of last resort.
Commercial: private plans where the provider contract sets most of the rules.
"Medicare is the federal program mainly for people 65 and over and some younger people with disabilities or permanent kidney failure. Original Medicare claims go to a regional contractor, and the rules come from national and local coverage policies, so they're fairly consistent. But a Medicare Advantage plan is run by a private insurer, so those claims go to that plan, not the contractor. Medicaid is run by each state within federal rules, so timely filing, authorization and even the forms can vary a lot, and many members are in managed care plans. It's also the payer of last resort, so any other coverage has to be billed first. Commercial plans are private, and most of what matters, like allowed amounts, filing limits and appeal steps, comes from the provider's contract and the plan's own policies. So before I call, I always check which of these I'm dealing with."
Saying all payers follow the same rules and deadlines.
Common rules: own plan before a spouse's; birthday rule for children; Medicaid last.
Medicare cases: employer plans or liability coverage can come before Medicare.
After primary: bill the secondary with the primary's payment details.
"The general rule is that a person's own plan, say from their employer, pays before a plan they're on as a dependent. For a child covered by both parents, many plans use the birthday rule, where the parent whose birthday comes earlier in the calendar year has the primary plan. The year of birth doesn't count, just the month and day. With Medicare it depends on things like whether the patient is still working and the size of the employer, and accident or workers' compensation coverage can come first. Medicaid almost always pays last. Once the primary pays, I send the claim to the secondary with the primary's payment and adjustment details, usually electronically or with the EOB attached. Sometimes it crosses over from the primary automatically, so I check that before sending it again."
Picking the primary by whichever card the patient showed first.
Deadline risk: claims near timely filing or appeal limits come first.
Value: higher balances before small ones within the same risk.
Efficiency: group by payer so one call or portal session covers several claims.
"First I'd sort by risk, not just age. Anything close to a timely filing limit or an appeal deadline goes to the top, because once that date passes the money is usually gone for good. Next I'd look at balance, so within the same risk level the bigger claims come first. Then I'd split out the claims that have no response at all, past the payer's normal processing time, because those might never have reached the payer. After that I'd group the list by payer. That way I can check several claims in one portal session or cover more than one on a single call, instead of waiting on hold for each one. The very old, small balances still get worked, but I'd review them to see if they need a small balance adjustment under the team's policy rather than hours of calls."
Working the list top to bottom or oldest first with no thought about deadlines.
Opening: your name, the provider, the reason for the call.
Identifiers: NPI and tax ID, then patient name, date of birth, member ID, date of service.
Close: status details, next step, rep's name and call reference number.
"Hi, my name is Alex, and I'm calling from the billing office of Riverside Family Clinic about a claim status. I have the provider's NPI and tax ID ready whenever you need them. The patient is John Carter, date of birth March 4, 1980, and I can read you the member ID whenever you're ready. The date of service is June 12, and the claim was billed electronically on June 14. Could you tell me the status of that claim? ... Okay, it's denied. May I have the claim number, the denial date, and the reason and remark codes? Is that something you can reprocess over the phone, or do you need a corrected claim or an appeal? What's the appeal deadline and where should I send it? Great. Before I go, may I have your name and the call reference number? Thank you so much for your help."
Starting to ask questions before giving identifiers, or ending the call without a reference number.
Situation: what the rep said or didn't say.
Your move: specific questions, calm tone, escalation if needed.
Outcome: what you got, and the reference number.
"I had a rep who kept saying the claim was denied for missing information and wanted to end the call. That's not something I can act on. So I stayed polite and asked very specific questions: which remark code is on the claim, which field or document is missing, and can it be sent by fax or does it need a corrected claim. She still wasn't sure, so I asked if a supervisor or a claims specialist could look at it. The supervisor found the payer was missing an itemized bill for that service, and gave me the fax number. I got the rep's name and the reference number, noted everything in the account, and the claim paid after we sent the bill."
Getting irritated with the rep, or accepting a vague answer and closing the account note with nothing actionable.
Verify: patient name, date of birth, member ID and payer on the call.
Trace: clearinghouse reports for acceptance or rejection and the payer ID used.
Act: resubmit within the filing limit, note everything, set a follow-up.
"First I'd make sure the rep and I are looking at the same patient. I'd spell the name, confirm the date of birth and the member ID, and ask if they can search by date of service instead. If it's still not there, I'd check our clearinghouse reports. If the claim was rejected, I'd fix the reason and resend it. If it was accepted but went to the wrong payer ID or address, I'd correct that. If the report shows the payer accepted it, I'd ask the rep whether it could be sitting under a different member ID or plan, and I'd keep that acceptance report as proof of timely filing. Then I'd resubmit, note the rep's name and reference number, and set a follow-up for when the payer should have processed it."
Resubmitting straight away without checking why it never arrived.
Corrected claim: our data was wrong, such as the member ID, date or units.
Appeal: the claim was right, but the payer's decision was wrong.
Marking it: use the payer's replacement code and original claim number.
"It comes down to whose mistake it was. If something on our claim was wrong, like the member ID, the date of service, the units or a missing modifier the coding team confirmed, I send a corrected claim. On the 1500 that's resubmission code 7 with the original claim number, and on electronic claims it's the replacement frequency code. Some payers handle corrections differently, like Medicare Part B, which uses a reopening instead, so I check the payer's rules. If the claim was correct and the payer still denied it, say for medical necessity, bundling or a timely filing denial where I have proof, that's an appeal, or a reconsideration first if the payer offers one. Sending a corrected claim when the claim was right just wastes time and can trigger a duplicate denial."
Appealing every denial by default, or resubmitting a fixed claim without marking it as a replacement.
First two: redetermination by the contractor, then reconsideration by an independent contractor.
Next two: a hearing before an administrative law judge, then the Medicare Appeals Council.
Last: judicial review in federal district court.
"Original Medicare has five levels. The first is redetermination, handled by the same Medicare contractor that processed the claim, but by different staff. If that fails, the second level is reconsideration by a Qualified Independent Contractor. The third is a hearing with an administrative law judge, the fourth is review by the Medicare Appeals Council, and the fifth is judicial review in federal district court. The judge hearing and the court level need the amount in dispute to be above a minimum that's updated each year. Each level has its own filing deadline counted from the date of the last decision, so I track those dates carefully. In practice, most of the claims I'd work get settled at the first or second level, especially if the first appeal includes strong documentation. And for simple clerical errors, a reopening is often faster than a formal appeal."
Saying you'd just call and ask the rep to reprocess a medical necessity denial, with no idea of the formal levels.
What happened: the target and how far off you were.
Real reason: the part that was in your control.
Change: what you did differently and the result.
"In my second month I was well short of my accounts-touched target for a week. Part of it was long hold times with one big payer, but when I looked honestly, the bigger problem was me. I was calling for every claim, even ones I could have checked on the payer's portal in a minute. I was also calling one claim at a time for the same payer. So I changed my routine. I checked status online first, grouped my calls by payer, and asked about two or three claims on the same call where the rep allowed it. I also used hold time to write notes on the last account. The next week I was back above target, and I've kept that routine since."
Blaming the payers or the target entirely, with nothing you changed yourself.
Mistake: what you did wrong, plainly.
Fix: how you found it and set it right.
Prevention: the habit you added afterwards.
"Early on I sent an appeal for one patient using another patient's claim number, because I had two similar accounts open at once. I caught it two days later when I was checking the follow-up list and the numbers didn't match. I told my team lead the same day, called the payer to ask that the wrong appeal be withdrawn, and sent the correct one with a cover note. Luckily both were still inside the appeal window. After that I made a rule for myself: one account open at a time, and I read the claim number and date of service back from the EOB before I send anything. It's slower by a few seconds, but I haven't repeated that mistake."
Claiming you've never made a mistake, or a story where you hid it until someone else found it.
Problem: what blocked payment and which team owned it.
Handoff: what you sent them and how clearly.
Follow-through: how you chased it and the outcome.
"At my last company I had a batch of claims denied because the payer bundled one service into another done the same day. I could see from the payer's note that a modifier might apply, but choosing a modifier is a coding decision, not mine. So I sent the coding team a short list with the claim numbers, the denial codes, the payer's remark and the date I needed an answer by because of the appeal window. One coder reviewed the notes and agreed the modifier was supported on most of them, but not two. I sent corrected claims for the ones she approved and adjusted the other two according to our policy. Everything was done inside the deadline, and she thanked me for sending it all in one clear list."
Saying you'd just add the modifier yourself to get the claim paid.
Verify: check whether this person is listed as authorized on the account.
Protect: share nothing if they aren't, however reasonable they sound.
Help: explain how the patient can authorise them or call directly.
"I'd be polite, but I wouldn't share anything until I've checked. First I'd look at the account to see if there's a signed authorization or a listed representative with that person's name, and verify their identity the way our process requires. If they're authorized, I can help them. If they're not, I'd explain that billing details are protected health information, and privacy laws, like HIPAA for US patients, don't let me share them without the patient's permission. Then I'd offer a way forward: the patient can call with them on the line and give verbal consent, or fill out our authorization form. Most people understand once you explain it's to protect their parent. I'd note the call on the account either way."
Sharing the details because the caller knew the patient's date of birth.
Attitude: audits catch what you can't see yourself.
Example: a piece of feedback you got and acted on.
Habit: how you check your own work between audits.
"I'm comfortable with it. In billing, a small miss like a wrong date in a note or a missing reference number can cost the next person a whole call, so I'd rather someone catch it. In my last role, an audit pointed out that my notes said what the rep told me but not what I did next. That was fair. Someone picking up the account couldn't tell if the appeal had gone out. So I started writing every note in the same order: who I spoke to, what they said, what I did, and when the next follow-up is. My audit scores went up after that. Between audits I pick two of my own accounts at the end of each shift and read the notes as if I were a stranger."
Getting defensive about audits or seeing them only as a threat to your score.
Share: payer tips, policy changes and useful phone paths.
Cover: help when someone is stuck or behind.
Hand over: clean notes so the next shift can pick up.
"On nights there are fewer managers around, so the team has to help itself. For me that means sharing what I learn straight away. If a payer changes an appeal address or I find a faster route through their phone menu, I post it for everyone rather than keeping it to myself. It also means helping when someone is stuck on a difficult call or falling behind, because we all share the team's numbers in the end. And it means leaving clean notes, so whoever picks up the account next doesn't have to call the payer again to find out what I already know. I also think keeping each other awake and in good spirits at four in the morning counts as teamwork."
Talking only about your own numbers and never mentioning sharing knowledge.
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