Top 20 Interview Questions & Answers for Medical Review Specialist – 2025

Preparing for a medical review specialist job interview? Look no further! Here are twenty up-to-date interview questions and accompanying answers to help you impress potential employers and demonstrate your expertise in the field. From understanding healthcare regulations to your experience working with medical records, we cover all essential areas of the role.

General Questions

• 1. Tell us about your experience in the medical field.
  Answer: I have been working in the medical field for the past five years. I began as a medical assistant before transitioning into a medical review specialist role. I am well-versed in healthcare regulations and medical terminology, and I have experience working with various medical records systems.
• 2. How do you stay updated on the latest healthcare regulations?
  Answer: I regularly attend seminars and workshops related to healthcare regulations. I also keep myself updated through industry-specific websites and newsletters. Additionally, my current job requires me to review and adhere to new regulations, so I am constantly learning and staying updated.
• 3. How do you handle difficult or confrontational situations with patients or coworkers?
  Answer: I always approach difficult situations with empathy and a calm demeanor. I listen to the concerns of the other party and try to understand their perspective. I also communicate openly and professionally, and I am willing to compromise and find a solution that works for everyone involved.
• 4. Can you provide an example of a time when you had to meet a tight deadline?
  Answer: In my previous role, I was responsible for reviewing medical records for a large number of patients. There was an unexpected surge in workload, and I had to review and process a high volume of records within a short deadline. I prioritized my tasks, stayed focused, and was able to meet the deadline without any errors.
• 5. How do you manage your tasks and ensure accuracy in your work?
  Answer: I am a very organized individual, and I always have a detailed plan for my tasks. I also use task management software to keep track of my assignments and deadlines. I am also very thorough in my work and always double-check my work for accuracy before submitting it.

Technical Skills & Experience

• 6. How familiar are you with medical coding and billing?
  Answer: I have a deep understanding of medical coding and billing, as I have been responsible for reviewing medical records and ensuring accurate coding and billing in my current and previous roles. I also possess comprehensive knowledge of ICD and CPT codes and stay updated on any changes or updates.
• 7. How do you ensure compliance with HIPAA regulations?
  Answer: I have a thorough understanding of the HIPAA regulations and consistently adhere to them in my work. I am extremely careful when handling sensitive patient information and always seek permission before disclosing any information. I also regularly review and update my knowledge of HIPAA regulations.
• 8. How do you handle a situation where you discover a medical error in a patient's record?
  Answer: If I discover a medical error in a patient's record, I immediately report it to the appropriate personnel and take steps to correct the error. I am also careful to document the error and my actions taken to correct it. I understand the importance of accuracy and precision in medical records.
• 9. Are you familiar with medical record systems and software?
  Answer: Yes, I have extensive experience working with various medical record systems and software, such as EMR and EHR. I am proficient in using these systems and can quickly learn and adapt to new software.
• 10. Have you ever dealt with insurance denials or appeals?
  Answer: Yes, I have experience handling insurance denials and appeals. I understand the importance of thorough documentation and providing necessary evidence and supporting documents to appeal a denial. I am also familiar with the necessary steps and requirements for insurance appeals.

Behavioral Questions

• 11. Can you tell me about a time when you had to handle a difficult client or patient?
  Answer: One time, a patient was unhappy with their treatment and was expressing their frustration in a loud and confrontational manner. I remained calm and listened to their concerns, acknowledging their feelings and offering a solution to address their issue. By the end of the conversation, the patient was much calmer and satisfied with the outcome.
• 12. How do you prioritize your tasks when you have multiple deadlines to meet?
  Answer: In my experience as a medical review specialist, I have learned the importance of setting priorities. I assess the urgency of each task, the amount of time each task will take, and prioritize based on importance and deadlines. I also have open communication with my team to ensure we are all on the same page.
• 13. Tell us about a time when you had to work with a team to achieve a common goal.
  Answer: In my previous role, I was part of a team responsible for implementing a new medical record system. We had to work together to learn the new system, train our colleagues, and troubleshoot any issues. Through effective communication and collaboration, we successfully implemented the new system within the allocated time frame.
• 14. How do you handle a situation where you have conflicting priorities?
  Answer: I have encountered situations where I have had to handle conflicting priorities. I take a step back and assess the importance and urgency of each task, and if necessary, I consult with my supervisor to re-prioritize. I am also flexible and willing to adjust my schedule if needed to ensure all tasks are completed to the best of my ability.
• 15. Do you have experience training or mentoring other employees?
  Answer: Yes, I have experience training and mentoring new employees. In my previous role, I was responsible for training new medical assistants on medical record management, and I also mentored a colleague who was new to the medical review specialist role. I enjoy sharing my knowledge and helping others grow in their roles.

Situational Questions

• 16. How would you handle a situation where a patient's medical records are missing important information?
  Answer: I would first determine the urgency of the information and then try to retrieve the missing information from the patient or their healthcare provider. If that is not possible, I would document the missing information and reach out to the patient's healthcare provider to obtain the necessary information.
• 17. If you were to notice a pattern of incorrect coding or billing, how would you address it?
  Answer: I would first verify the accuracy of the incorrect coding or billing and then bring it to the attention of my supervisor. I would also document the issue and any steps taken to address and correct it. I understand the importance of integrity and accuracy when it comes to medical coding and billing.
• 18. How would you handle a situation where you are unsure of how to code or bill a particular procedure?
  Answer: I would consult with my supervisor or a more experienced colleague for guidance. If necessary, I would also research the specific procedure and review coding and billing guidelines before proceeding. I am always willing to ask for help when needed to ensure accuracy in my work.
• 19. Can you provide an example of a time when you had to make a difficult decision while reviewing a patient's medical records?
  Answer: In my previous role, I came across a situation where a patient's treatment plan deviated from the standard protocol. After carefully reviewing the records and consulting with the patient's healthcare provider, I made the difficult decision to bring it to the attention of my supervisor. The issue was resolved, and the patient's treatment plan was adjusted accordingly.
• 20. How do you prioritize urgent and non-urgent tasks?
  Answer: I assess the urgency and importance of each task and prioritize accordingly. If there are multiple urgent tasks, I prioritize based on deadlines and consult with my supervisor if necessary. I also understand the importance of timely completion of tasks, so I am always willing to adjust my schedule to ensure everything gets done in a timely manner.