Interview guide · Healthcare support roles
Medical billing and coding interview questions
In short
Good medical billing interview questions test whether a candidate can get a claim paid the first time and work a denial when it is not. This page gives 34 questions for billers, coders and revenue cycle (RCM) staff, covering CPT and ICD-10 coding, denials, A/R follow-up, compliance and productivity, with answers to listen for and a scorecard.
A medical biller or coder is paid to turn clinical documentation into money without breaking any rules on the way. The job rewards people who read carefully, know the payer rules cold, and keep working an account after the first denial instead of writing it off. It punishes people who guess at codes, rush through edits or treat the A/R aging report as somebody else's problem. Credentials such as the AAPC's CPC or AHIMA's CCS tell you someone passed an exam. They do not tell you whether that person can clear a 90-day bucket or explain a CO-97 denial to a provider who is sure the visit was billable.
Use the questions below in two passes. A 15-minute phone screen covers the opener and a few role-specific questions to confirm the candidate has actually worked claims (not just studied for them). The main interview adds behavioral and situational questions plus a short practical exercise: a de-identified superbill to code, or a remittance with three denials to triage. Score every answer against the scorecard at the bottom before the panel talks. Precision matters more here than in most roles, so borrow probes from our attention to detail interview questions if your team has had accuracy problems.
What to look for in a medical biller and coder
- Payer and code-set fluencyStrong candidates talk naturally about CPT, ICD-10-CM, HCPCS Level II, modifiers and NCCI edits, and know that Medicare, Medicaid and commercial plans follow different rules for the same service.
- Accuracy before speedOne wrong modifier repeated across a month of claims can cost a practice thousands or trigger an audit. You want people who check their own work and are comfortable with quality audits.
- Persistence on unpaid claimsMost lost revenue sits in accounts nobody followed up on. Good billers work the aging report by dollar value and timely filing deadline, not by whatever is easiest.
- Compliance judgmentCoders are regularly asked, directly or indirectly, to code up. The right hire knows the difference between documentation that supports a higher level and wishful thinking, and will raise it.
- Clear communication with providers and patientsBillers query physicians about missing documentation and explain balances to confused patients. Both need plain language and patience.
- Comfort with systems and dataThe work happens in practice management systems, EHRs, clearinghouse portals and payer websites. Candidates should learn new software quickly and be able to read a denial report.
Opening and background questions
Walk me through your billing or coding experience. What specialties, which payers and which systems?
- Why ask it
- Specialty and payer mix shape everything. A biller from a dermatology practice and one from a hospital outpatient department have very different habits.
- A strong answer
- Names the specialties (for example orthopedics, behavioral health), the payer mix by rough percentage, the practice management and EHR systems used, and whether they did professional (837P) or facility (837I) billing.
- Red flags
- Cannot name the systems or specialties, or describes only training coursework when the resume shows years of work.
Which credentials do you hold, and which are you working toward?
- Why ask it
- Confirms what the resume claims and shows how the candidate thinks about professional development.
- A strong answer
- States the credential precisely (CPC, CPB, CCS, RHIT), when they earned it, how they keep CEUs current, and why it fits their career path.
- Red flags
- Vague about the credential's exact name or status, or a credential listed on the resume has lapsed and they do not mention it.
What part of the revenue cycle do you know best, and where are you weakest?
- Why ask it
- RCM runs from scheduling and eligibility to final payment. Honest self-assessment tells you where you will need to train.
- A strong answer
- Picks a specific stage (charge entry, coding, denials, payment posting, patient collections) and admits a real gap, with something they are doing about it.
- Red flags
- Claims to be equally expert at every stage.
On a typical day in your last role, how many claims, charts or accounts did you handle?
- Why ask it
- Gives you a productivity baseline and shows whether the candidate tracks their own output.
- A strong answer
- Gives a number with context, such as 25 to 35 outpatient charts an hour for simple E/M coding or 60 to 80 follow-up accounts a day, and explains what slowed them down.
- Red flags
- Has no idea of their own volume or quotes a number far out of line with the work described.
Why medical billing, and why this kind of practice or company?
- Why ask it
- Separates people who chose the work from people who drifted into it, and tests whether they researched you.
- A strong answer
- Connects their interest to something concrete: liking puzzles in denials, wanting to move into auditing, or experience with your specialty or payer mix.
- Red flags
- Only mentions remote work or pay, with nothing about the work itself.
Coding and billing knowledge questions
Explain the difference between CPT, ICD-10-CM and HCPCS Level II codes, and how they relate on a claim.
- Why ask it
- A foundation question. Anyone who has billed should answer it in under a minute.
- A strong answer
- CPT describes procedures and services, ICD-10-CM describes diagnoses and establishes medical necessity, HCPCS Level II covers supplies, drugs, DME and some services not in CPT. Diagnosis pointers link each line item to the supporting diagnosis.
- Red flags
- Mixes up which code set describes the diagnosis versus the service.
When would you use modifier 25, and what makes payers look hard at it?
- Why ask it
- Modifier 25 is one of the most audited modifiers. It tests whether the candidate understands separately identifiable services.
- A strong answer
- Used on an E/M service on the same day as a procedure when the E/M is significant and separately identifiable, supported by documentation beyond the usual pre-procedure assessment. Mentions that routine use on every procedure visit draws audits.
- Red flags
- Says they add modifier 25 whenever a claim denies for bundling.
What are NCCI edits, and what do you do when a claim hits one?
- Why ask it
- Tests understanding of bundling and the difference between a legitimate override and unbundling.
- A strong answer
- National Correct Coding Initiative edits identify code pairs that should not be billed together. They check the modifier indicator, review documentation for a distinct procedure (separate site, session or encounter), and only then use 59 or an X modifier.
- Red flags
- Treats modifier 59 as the standard fix for any edit.
How do you choose the E/M level for an office visit under the current guidelines?
- Why ask it
- Since 2021, office E/M codes are chosen on medical decision making or total time. Candidates who still talk about counting history and exam elements have not kept up.
- A strong answer
- Explains selection by medical decision making (problems, data, risk) or total time on the date of service, and knows that time includes non-face-to-face work by the provider on that day.
- Red flags
- Describes bullet-counting the exam as the main method for office visits.
What is the difference between a CMS-1500 and a UB-04, and when does each apply?
- Why ask it
- Confirms whether the candidate has worked professional, facility or both types of claims.
- A strong answer
- CMS-1500 (837P electronically) for physicians and other professional services; UB-04 (837I) for hospitals and facilities, with revenue codes, type of bill and occurrence codes.
- Red flags
- Has never heard of one of the two but claims hospital and physician experience.
How do you read an ERA or EOB, and what do CARC and RARC codes tell you?
- Why ask it
- Payment posting and denial work depend on reading the 835 remittance correctly.
- A strong answer
- Explains group codes (CO, PR, OA), claim adjustment reason codes for why the payer adjusted, remark codes for more detail, and how to decide whether a balance is a write-off, patient responsibility or something to appeal.
- Red flags
- Posts adjustments without knowing what CO versus PR means for the patient balance.
How does coordination of benefits work when a patient has Medicare and a commercial plan?
- Why ask it
- Primary and secondary mistakes are among the most common avoidable denials.
- A strong answer
- Describes Medicare Secondary Payer rules (for example employer group plan size and active employment), verifying order at each visit, billing the primary first and sending the secondary with the primary's remittance.
- Red flags
- Assumes Medicare is always primary.
What is timely filing, and how do you keep claims from aging past it?
- Why ask it
- Missed filing limits are pure lost revenue with almost no appeal route.
- A strong answer
- Knows limits vary by payer (Medicare is generally 12 months from the date of service, many commercial plans are shorter, some 90 days) and keeps a payer rule sheet or work queue sorted by deadline.
- Red flags
- Thinks there is one universal deadline.
What metrics would you look at to judge the health of a billing operation?
- Why ask it
- Separates task-doers from people who understand the operation they work in.
- A strong answer
- Mentions clean claim rate (many teams aim for 95 percent or higher), first-pass denial rate, days in A/R, percentage of A/R over 90 days, net collection rate and denial reasons by category.
- Red flags
- Can only name total dollars collected.
Behavioral questions
Tell me about a denial you overturned that others had given up on.
- Why ask it
- Shows persistence and the ability to build a winning appeal.
- A strong answer
- Names the denial reason, what documentation or policy they found, how they wrote the appeal or reconsideration, the level of appeal reached and the dollar amount recovered.
- Red flags
- The story ends at resubmitting the same claim unchanged.
Describe a time you found a coding or billing error that affected many claims. What did you do?
- Why ask it
- Tests ownership and whether the candidate thinks in patterns rather than single claims.
- A strong answer
- Found the root cause (a charge master error, a template default, a misunderstood payer rule), quantified the impact, escalated, corrected the affected claims and helped fix the source.
- Red flags
- Fixed the claims they saw and never looked for the cause.
Tell me about a time a provider pushed back on your query about documentation.
- Why ask it
- Coders must query physicians without leading them toward a code. This tests tact and compliance.
- A strong answer
- Describes a non-leading, specific query, staying calm, citing the guideline or payer policy, and the outcome, including cases where the provider was right.
- Red flags
- Suggests the answer the provider should document, or gave up and coded anyway.
Tell me about the worst A/R backlog you have inherited. How did you work it down?
- Why ask it
- Many billing hires walk into a mess. You want a method, not heroics.
- A strong answer
- Sorted by timely filing risk and dollar value, grouped by payer and denial reason to batch the work, set weekly targets and reported progress, for example bringing 90-plus day A/R from 35 percent to under 20 percent over a quarter.
- Red flags
- Worked accounts oldest first or alphabetically with no plan.
Describe a time you had to learn a new payer policy or system quickly.
- Why ask it
- Payer rules and software change constantly. Learning speed predicts how fast a new hire becomes productive.
- A strong answer
- Explains how they learned (payer bulletins, provider manuals, test claims, asking the rep), what they built for the team such as a cheat sheet, and how quickly claims started paying.
- Red flags
- Waited for formal training before doing anything.
Tell me about a time you were asked to bill something you thought was not supported.
- Why ask it
- Directly tests integrity. Upcoding and billing for undocumented services can create False Claims Act exposure.
- A strong answer
- Explains what they saw, why it was not supported, how they raised it through the right channel (supervisor, compliance) and that they did not bill it as asked.
- Red flags
- Billed it because a manager said so, or cannot recall ever questioning a charge.
Tell me about a difficult conversation with a patient about a bill.
- Why ask it
- Many billers handle patient calls. This tests empathy, clarity and knowledge of balance billing rules.
- A strong answer
- Explained the balance in plain words (deductible, coinsurance), checked whether the claim was processed correctly, offered a payment plan or financial assistance where the policy allowed, and documented the call.
- Red flags
- Blamed the patient's insurance and ended the call.
Situational questions
A payer denies a batch of 40 claims for the same reason on the same day. What do you do first?
- Why ask it
- Tests triage and pattern recognition.
- A strong answer
- Checks whether it is a payer-side error (call the provider rep, check bulletins), a front-end issue such as an eligibility or credentialing change, or a coding pattern, then fixes the cause before reworking all 40.
- Red flags
- Starts appealing each claim one at a time without looking for the common cause.
You notice a provider documents nearly every visit at the highest E/M level. What would you do?
- Why ask it
- Shows whether the candidate understands audit risk and the right escalation route.
- A strong answer
- Compares to the specialty's typical distribution, reviews a sample of notes against the guidelines, and raises findings with the coding supervisor or compliance rather than confronting the provider alone.
- Red flags
- Says it is not their job, or quietly downcodes without telling anyone.
A claim is 10 days from the payer's timely filing limit and you are missing a referral number. What now?
- Why ask it
- Tests urgency and creative problem solving under a hard deadline.
- A strong answer
- Contacts the referring office the same day, checks the payer portal, submits by the deadline with proof of timely filing if the referral comes late, and documents every contact attempt.
- Red flags
- Waits for the referral without tracking the deadline.
A patient insists they should not owe anything because their plan is in-network. How do you respond?
- Why ask it
- Tests patience and the ability to explain cost sharing without jargon.
- A strong answer
- Separates network status from deductible and coinsurance, reviews the remittance with them, and checks whether any surprise billing protections under the No Surprises Act apply if the service involved an out-of-network provider at an in-network facility.
- Red flags
- Reads codes to the patient or tells them to call their insurance and hangs up.
Your productivity target is 70 accounts a day, but today's queue is full of complex appeals. How do you handle it?
- Why ask it
- Tests honesty about trade-offs between speed and quality.
- A strong answer
- Prioritizes by dollars and deadlines, tells the supervisor early that the queue is unusual, tracks time spent so the target can be adjusted, and does not rush appeals to hit a count.
- Red flags
- Would skip the hard accounts to hit the number.
You find a payment posted to the wrong patient account last month. What steps do you take?
- Why ask it
- Tests attention to detail and HIPAA awareness, since statements may already have gone out.
- A strong answer
- Reverses and reposts correctly, checks whether a statement or other information was sent to the wrong patient, reports it to the supervisor or privacy officer for a breach assessment, and corrects the posting process.
- Red flags
- Fixes the posting quietly and does not consider whether protected health information was disclosed.
A newly credentialed provider's claims are all denying. Where do you look?
- Why ask it
- Credentialing and enrollment problems cause sudden denial spikes and are often missed by billers who only look at codes.
- A strong answer
- Checks the effective date of enrollment with each payer, the NPI and taxonomy on the claim, group versus individual linkage, and whether claims can be held or resubmitted once enrollment is active.
- Red flags
- Assumes it is a coding problem and starts changing codes.
Questions for senior billers, coders and team leads
How would you set up a coding quality audit program for a team of eight coders?
- Why ask it
- Tests whether a senior candidate can build controls, not just do the work.
- A strong answer
- Describes sample size per coder (for example 20 to 30 charts per quarter, more for new hires), an accuracy target such as 95 percent, how errors are categorized, feedback sessions and focused re-audits.
- Red flags
- Would audit only when a payer complains.
Days in A/R have climbed from 38 to 52 over six months. How do you find out why?
- Why ask it
- Tests analytical depth and familiarity with RCM reporting.
- A strong answer
- Breaks A/R down by payer, aging bucket, denial reason and front-end versus back-end cause, checks charge lag and claim submission lag, and looks for staffing or system changes that line up with the rise.
- Red flags
- Proposes hiring more people before diagnosing anything.
How do you train a new biller to be productive within 60 days?
- Why ask it
- Billing teams in BPO and RCM firms hire constantly. Leads must ramp people fast.
- A strong answer
- Starts them on one payer or one work queue, pairs them with a senior biller, uses real accounts with review before submission, sets ramping targets by week and audits a higher share of their work early.
- Red flags
- Hands them the full queue and a policy binder.
What would you change first about a denial management process that only tracks total denials?
- Why ask it
- Shows whether the candidate can move a team from rework to prevention.
- A strong answer
- Categorizes denials by root cause and owner (registration, authorization, coding, payer error), reports them back to the departments that create them, and tracks preventable denials as a separate rate.
- Red flags
- Focuses only on working denials faster.
How do you keep a team current with annual CPT and ICD-10 updates?
- Why ask it
- Code sets change every year (ICD-10-CM on October 1, CPT on January 1). Leads must plan for it.
- A strong answer
- Reviews the new, revised and deleted codes for the specialty ahead of time, updates charge master and templates, runs short team sessions and audits the first weeks of claims after the change.
- Red flags
- Relies on the software vendor to handle it.
A client or department head asks you to stop appealing denials under $50. How do you respond?
- Why ask it
- Tests business judgment. Small denials add up and often signal a fixable root cause.
- A strong answer
- Agrees some small balances are not worth individual appeals, but proposes looking at volume and cause first, since 2,000 denials at $40 is $80,000, and fixing the cause usually costs less than writing it off.
- Red flags
- Either refuses outright or agrees without looking at the totals.
How do you handle a coder whose speed is high but accuracy is slipping below target?
- Why ask it
- Tests people management and the speed-versus-quality trade-off.
- A strong answer
- Shares the audit data privately, identifies the error pattern, adjusts targets or adds focused review until accuracy recovers, and documents the plan.
- Red flags
- Praises the speed and ignores the errors until a payer audit finds them.
Sample answers
At an orthopedic group, we had about 60 knee injection claims from one commercial payer denied as not medically necessary, roughly $21,000 in total. They had been sitting in the 90-plus bucket because two people had resubmitted them and gotten the same denial. I pulled the payer's medical policy and saw it required documented failure of conservative treatment for at least six weeks. Our providers were documenting physical therapy, but in a separate note the payer never received. I built a short appeal template that cited the policy section, attached the PT notes and the visit note together, and sent the first ten as a test. Eight were paid on first-level appeal. We sent the rest and recovered about $17,000. I also worked with the front desk so PT notes were attached to the claim from then on.
I would not touch the individual claims yet. First I would read the reason and remark codes and check whether all 40 share something: same provider, same location, same CPT code or same date range. If it is one provider, I check enrollment and credentialing with that payer, because a lapsed enrollment would explain it. If it is one code, I check the payer's recent bulletins for a policy change. Then I call the provider rep, since sometimes the payer has a system error and will reprocess everything on their side. Once I know the cause, I fix it at the source and rework the batch in one go, and I let my supervisor know so it goes on the denial log.
A practice manager asked me to add a prolonged service code to a set of visits because the doctor said the appointments had run long. When I looked at the notes, none of them documented total time, and the visits were coded on medical decision making. Without time documented, there was nothing to support the add-on. I explained that to the manager, showed her the guideline and suggested the doctor document total time going forward if visits really were running long. She was not happy at first, so I also told our compliance lead, just so it was on record. We did not bill the code. A month later the doctor started documenting time and we billed it correctly when it applied.
Interview scorecard
| Competency | Weight | Strong (4–5) | Weak (1–2) |
|---|---|---|---|
| Coding and payer knowledge | 30% | Answers code-set, modifier, NCCI and coordination of benefits questions accurately and explains payer differences without prompting. | Relies on general statements, mixes up code sets or treats modifiers as a way around edits. |
| Accuracy and quality habits | 20% | Describes specific self-checks, welcomes audits, and the practical exercise has few or no errors. | Talks only about speed or has several errors on the practical exercise. |
| Denial and A/R follow-up | 20% | Prioritizes by deadline and dollars, looks for root causes, and gives real recovery examples with numbers. | Works accounts in no particular order and resubmits without changes. |
| Compliance and integrity | 15% | Recognizes unsupported billing, escalates through the right channel and understands HIPAA basics. | Would bill whatever a provider or manager requests. |
| Communication | 15% | Explains billing concepts to patients and providers in plain language and writes clear, non-leading queries. | Uses jargon with patients or becomes defensive with providers. |
Score each competency from 1 to 5 straight after the interview, before discussing the candidate with anyone else, then multiply by the weight.
How to structure a medical billing interview
For an experienced biller or coder, three steps are usually enough, and the whole process should take under two weeks. Good coders with active credentials get offers quickly.
- Phone or video screen, 15 to 20 minutes. Confirm specialties, payers, systems, credential status and pay expectations. Ask two knowledge questions from the list above. Our phone screen questions cover the logistics side.
- Practical exercise, 30 to 45 minutes. Give five de-identified encounters to code, or a remittance with a mix of paid, denied and partially paid lines to triage. Use the same exercise for every candidate and score it against a key. This one step tells you more than any interview question.
- Structured interview, 45 minutes. The billing supervisor plus one peer or the RCM manager. Use six to eight questions from the behavioral and situational groups and score them separately before discussing.
For coders, ask about the specific code ranges they will work. For A/R and follow-up roles, weight the denial and payer questions more heavily. For payment posting, add a reconciliation exercise: deposit total versus posted total with one hidden error. Entry-level billers without claims experience need a different approach. Focus on accuracy, typing and system skills from our data entry interview questions, and on how they learn, then train the payer knowledge. Front-office candidates who handle registration and eligibility are better assessed with our medical receptionist interview questions. For the role definition itself, the billing representative job description and health information coder job description are useful starting points.
Mistakes interviewers make when hiring billers and coders
Treating the credential as the assessment. A CPC shows exam knowledge. It does not show whether someone can work a messy A/R queue for eight hours. Always run a practical exercise.
Hiring for the wrong specialty or claim type. A coder who has done only professional fee coding in family practice will need real time to learn inpatient facility coding or anesthesia. That may be fine, but price it into the ramp plan rather than discovering it in month two.
Ignoring the compliance question. Teams under pressure to collect sometimes reward billers who never push back. That is how practices end up repaying overpayments, or worse. Ask at least one integrity question and score it.
Not checking productivity claims. If a candidate says they coded 300 charts a day, ask what kind. Simple radiology reads and complex surgical cases are not comparable. Ask for the accuracy rate that went with the number.
Letting the remote question decide. Many billing roles are remote, and many candidates screen for that first. Remote work is fine, but ask how they managed their queue without supervision and how they protect patient information at home, including screen privacy and secure connections.
Hiring billers in volume for RCM and healthcare BPO teams
Revenue cycle outsourcing firms and large health systems often hire billers in classes of 10 to 30 at a time, usually for A/R follow-up and payment posting. At that volume, consistency matters more than any single great question.
- Automate the first filter. Use knock-out questions for credential status, experience with your claim type and shift availability, then send qualified applicants a short online coding or remittance quiz. A 15-question quiz with a pass mark around 70 percent removes most unqualified applicants before anyone spends interview time.
- Use one structured interview for everyone. Pick five questions, write anchored scores for each and train interviewers on them. Structured, scored interviews are far easier to defend if a hiring decision is challenged, and they let you compare candidates across recruiters and sites.
- Use asynchronous video or AI-assisted screening for the first conversation. Candidates answer the same three or four questions on their own schedule, and reviewers score recordings against the rubric. It suits billing well because most of the work is solitary and screen-based.
- Measure quality of hire. Track 90-day productivity, first audit accuracy and early attrition by source and by interviewer. If one recruiting channel produces hires who fail their first audit, change the screen for that channel.
Whatever you automate, keep the scoring criteria job-related and apply them the same way to everyone, and keep a person in the decision for anyone the screen rejects on borderline results.
Frequently asked questions
What are the most common medical biller interview questions?
Expect questions on the difference between CPT, ICD-10-CM and HCPCS codes, how to handle a denied claim, how to read an EOB or ERA, coordination of benefits, timely filing limits, and how you prioritize an A/R aging report. Behavioral questions usually cover a denial you overturned, an error you found and a difficult patient conversation about a bill.
What should I ask in medical coder interview questions?
Focus on code selection and guidelines: E/M level selection by medical decision making or time, modifier 25 and 59 use, NCCI edits, querying providers without leading them, and how they keep up with annual code updates. Add a short coding exercise with de-identified charts, and ask about their accuracy rate on past audits.
What are good RCM interview questions?
Revenue cycle questions should cover the whole flow: eligibility and authorization at the front end, charge capture and coding, claim scrubbing, denial management, payment posting and patient collections. For senior roles, ask how they would diagnose rising days in A/R or a falling clean claim rate, and which metrics they report weekly.
Should medical billing candidates take a skills test?
Yes. A short, job-related practical test is the most reliable part of a billing interview. Keep it to 30 to 45 minutes, use de-identified or fictional data, give every candidate the same test and scoring key, and make sure it reflects the actual work of the role so it stays job-related and fair.
What is the difference between a medical biller and a medical coder?
Coders read clinical documentation and assign diagnosis and procedure codes. Billers create and submit claims, post payments, follow up on unpaid or denied claims and handle patient balances. In smaller practices one person often does both, which is why many interviews mix medical billing and coding interview questions.
What red flags should I watch for when interviewing medical billers?
Watch for candidates who use modifiers to get around edits, who would bill what a manager requests without checking documentation, who cannot explain what a denial code means, or who describe working accounts with no prioritization. Inflated productivity numbers with no accuracy figure are another warning sign.