Top 20 Interview Questions & Answers for Medical Reimbursement Specialists - 2025

As the healthcare industry continues to evolve, the role of medical reimbursement specialists has become increasingly important. These professionals are responsible for working with insurance companies and healthcare providers to ensure timely and accurate reimbursement for medical services. If you're preparing for an interview for a medical reimbursement specialist role, here are 20 questions and answers to help you showcase your knowledge and skills in this field.

General Questions

• 1. Tell us about your previous experience as a medical reimbursement specialist.
  Answer: I have been working as a medical reimbursement specialist for the past 5 years at XYZ Hospital. Before that, I worked for 2 years at ABC Medical Center. In total, I have 7 years of experience in this role.
• 2. How do you stay updated on the constantly changing billing and coding regulations?
  Answer: I make sure to regularly attend seminars and workshops, read industry publications, and stay in touch with my colleagues to stay updated on any changes in billing and coding regulations. I am also certified by the AAPC and regularly take continuing education courses to maintain my knowledge.
• 3. How do you handle disagreements or disputes with insurance companies regarding claim denials?
  Answer: I always approach these situations with a calm and professional demeanor. First, I review the claim thoroughly to ensure it is accurate and within the guidelines of the insurance company. Then, I gather any necessary documentation and provide a written appeal with supporting evidence. If the dispute remains unresolved, I arrange for a conference call with the insurance company to further discuss and negotiate the claim.
• 4. How do you prioritize and manage your workload as a medical reimbursement specialist?
  Answer: I have a system in place where I prioritize tasks based on urgency and importance. I also constantly evaluate and adjust my workload as needed to ensure that I meet all deadlines and keep up with the high volume of claims.
• 5. Can you walk us through your experience using electronic health record (EHR) systems?
  Answer: I am proficient in using a variety of EHR systems, including EPIC, Cerner, and Allscripts. I have worked with these systems for several years and am familiar with their functions and features, such as submitting claims, tracking patient data, and generating reports.

Behavioral Questions

• 6. Tell us about a time when you had to deal with a particularly difficult insurance claim.
  Answer: In my previous role, I had a situation where an insurance company denied a claim for a patient's surgery because they deemed it "medically unnecessary". I had to collaborate with the physician and provide extensive documentation to prove the necessity of the surgery. After a few rounds of appeals and negotiations, we were able to get the claim approved.
• 7. How do you handle tight deadlines and high-pressure situations?
  Answer: I am no stranger to tight deadlines and high-pressure situations in this line of work. I make sure to stay organized and focused, prioritize tasks, and seek help if needed. I also have strong time management skills and am able to remain calm and efficient under pressure.
• 8. Tell us about a time when you had to collaborate with a team to complete a project.
  Answer: In my current role, I worked with a team of medical coders to implement a new billing system. We had to ensure that all coding was accurate and compliant with current guidelines. I assigned specific tasks to each team member, monitored progress, and provided support where needed. Together, we successfully completed the project on time and with minimal disruptions to our daily workload.
• 9. How do you handle working with difficult or frustrated patients?
  Answer: I understand that dealing with medical bills and insurance claims can be overwhelming for patients. I always approach these situations with empathy and patience, actively listen to their concerns, and do my best to resolve their issues. I also provide clear explanations and options for payment plans or financial assistance programs.
• 10. Tell us about a time when you had to handle confidential information in a professional setting.
  Answer: In my current role, I often handle patients' personal and confidential information. I make sure to adhere to all HIPAA regulations and maintain strict confidentiality in all aspects of my work. I also take extra precautions, such as password protection and secure file storage, to secure this information.

Situational Questions

• 11. What would you do if a patient's insurance company refused to cover a necessary medical procedure?
  Answer: I would review the situation and gather all necessary information and documentation. Then, I would work with the physician and the patient to determine the best course of action, which could include filing an appeal or negotiating with the insurance company.
• 12. How would you handle a situation where you discovered a mistake in a patient's medical records that led to incorrect billing?
  Answer: If I discovered a mistake in a patient's medical records, I would immediately inform my supervisor and correct the error. I would also communicate with the patient and their insurance company to ensure that the error is resolved and the correct billing is submitted.
• 13. What would you do if a software system glitch caused several claims to be submitted with incorrect billing codes?
  Answer: I would first identify the extent of the issue and communicate it to my supervisor and the software vendor. I would then work with my team to manually review and correct the codes for these claims. I would also ensure that the software issue is resolved and implement any necessary safeguards to prevent similar issues in the future.
• 14. How would you handle a conflict with a coworker regarding a patient's billing?
  Answer: I would approach my coworker and discuss the issue in a professional and respectful manner. I would listen to their perspective and work together to find a resolution that is in the best interest of the patient and adheres to billing regulations.
• 15. What would you do if you had to simultaneously submit claims for two different insurance companies with different guidelines and requirements?
  Answer: I would carefully review the guidelines and requirements for each insurance company, ensure that the necessary documentation is attached to each claim, and prioritize and submit the claims according to their respective deadlines. I would also make sure to adhere to all billing and coding regulations for each company.

Technical Skills & Experience

• 16. What experience do you have with ICD-10 codes?
  Answer: I have been using ICD-10 codes for the past 4 years in my current role. I have a deep understanding and knowledge of the codes and am able to accurately assign them to diagnoses and procedures.
• 17. How do you handle claim denials due to incorrect coding?
  Answer: First, I review the claim and ensure that the coding was correct and within the guidelines. If there was an error, I correct it and resubmit the claim. If the coding was accurate and the error was on the insurance company's end, I gather supporting documentation and file an appeal.
• 18. Can you explain the concept of medical necessity and its importance in billing and coding?
  Answer: Medical necessity refers to the medical need for a service or procedure based on a patient's symptoms and diagnosis. It is crucial in billing and coding as it determines whether a service or procedure is reimbursable by insurance companies. Failure to prove medical necessity can result in claim denials and even fraud accusations.
• 19. How do you handle medical records that are missing information or documentation?
  Answer: In these situations, I collaborate with the physician or healthcare provider to obtain the missing information. If this is not possible, I document the missing information and submit the claim with a note explaining the situation. I also make sure to follow up and request the missing information from the appropriate party.
• 20. Are you familiar with the different types of insurance plans, such as PPO, HMO, and POS?
  Answer: Yes, I am familiar with the different types of insurance plans and their characteristics. For example, PPO plans offer more flexibility in choosing healthcare providers, while HMO plans require patients to stay within a network of providers. Understanding these differences is crucial in ensuring accurate billing and claim submission.