Medical Biller and Coder Interview Questions and Answers
20 common Medical Biller and Coder interview questions with strong sample answers, grouped by round.
- 20 questions with sample answers
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Screening medical biller and coder interview questions4 questions
- 1
Why did you choose medical billing and coding?
I like detailed, rule-based work that has a real impact, and medical billing and coding is exactly that. Accurate coding makes sure providers are paid correctly and patients' records are right, and I enjoy the problem solving involved in working through denials. I also like that the field keeps changing, with code updates and payer rules, so I am always learning something new.
- 2
Tell me about your experience and certifications.
I hold a professional coding certification and have four years of experience at a multi-specialty outpatient practice. I code office visits and procedures using ICD-10-CM, CPT and HCPCS, submit claims, post payments, work denials and handle patient billing questions. I keep my certification current with continuing education, which also keeps me up to date with annual code changes.
- 3
Which billing software and EHR systems have you used?
I have used Epic for charge review and claims, and athenahealth at my previous job, along with payer portals for eligibility checks and claim status. I am comfortable with clearinghouse tools for claim submission and rejections, and with Excel for tracking denials and aging reports. I learn new systems quickly because the billing workflow is similar across them.
- 4
Which specialties are you most familiar with?
Most of my experience is in family medicine, internal medicine and orthopedics, including evaluation and management visits, injections, minor procedures and imaging. I have also coded some cardiology. Each specialty has its own common codes, modifiers and payer rules, so I spend time learning the documentation patterns when I start with a new specialty.
Skill-based medical biller and coder interview questions4 questions
- 5
How do you make sure your coding is accurate?
I code only from the documentation in the record, never from assumptions, and I check that diagnosis codes support the procedures billed. I use current code sets and payer guidelines, pay attention to modifiers and bundling rules, and look up anything I am unsure about. When documentation is unclear or incomplete, I send a query to the provider rather than guessing.
- 6
How do you handle a denied claim?
I review the denial reason and the explanation of benefits, then check the claim against the documentation, coding and payer rules to find the cause. If it was an error on our side, such as a missing modifier, I correct and resubmit. If I believe the denial is wrong, I prepare an appeal with supporting documentation within the payer's deadline. I also track denial trends to prevent repeats.
- 7
What is the difference between ICD-10-CM and CPT codes?
ICD-10-CM codes describe the patient's diagnosis or reason for the visit, while CPT codes describe the procedures and services provided. HCPCS Level II codes cover supplies, drugs and some services not in CPT. On a claim, the diagnosis codes must support the medical necessity of the procedures billed, which is why linking them correctly matters so much.
- 8
How do you verify insurance and eligibility before services?
I check the patient's coverage through payer portals or the clearinghouse before the appointment, confirming active coverage, plan type, copays, deductibles and whether the service needs prior authorization. I update the patient's information in the system and flag issues to the front desk or patient. Catching eligibility problems early prevents many denials.
Role-specific medical biller and coder interview questions4 questions
- 9
How do you query a provider about documentation?
I keep queries clear, specific and non-leading, asking the provider to clarify the documentation rather than suggesting what they should write. I explain briefly why the information is needed, for example to support the level of service billed. I follow the practice's query process and keep a record. Good relationships with providers make queries quick and routine.
- 10
How do you keep up with coding and billing changes?
I complete continuing education for my certification, review the annual code updates and payer bulletins, and follow updates from coding associations. When changes affect our practice, I share a short summary with colleagues and update our templates or cheat sheets. Staying current protects the practice from denials and compliance risk.
- 11
How do you handle patient billing questions?
I listen to the patient's question, review their account and explain the charges in plain language, including what insurance paid and why they owe the balance. If there is an error, I correct it promptly. If they cannot pay in full, I explain payment plan options according to practice policy. Patients appreciate clear, patient explanations.
- 12
How do you protect patient information in billing work?
I follow HIPAA and practice policies: accessing only the information I need for the task, verifying identity before discussing any account, sending information only through secure channels and keeping my workstation locked when I step away. I am careful with printed statements and shred anything with patient details. Billing involves a lot of sensitive data, so privacy is part of every task.
Behavioral medical biller and coder interview questions4 questions
- 13
Tell me about a time you reduced denials.
Our practice had a high rate of denials for a common injection because of a missing modifier. I tracked the denials, identified the pattern and worked with the providers and front desk to update the charge template and add a check before submission. Denials for that service dropped sharply over the next two months, and the practice recovered revenue from the appeals.
- 14
Tell me about a time you found a coding error.
During a review, I noticed a provider was consistently selecting a higher visit level than the documentation supported. I prepared examples and met with the practice manager and provider to review the documentation requirements, focusing on education rather than blame. The provider adjusted their documentation, which reduced compliance risk for the practice.
- 15
Tell me about a time you dealt with an upset patient about a bill.
A patient called upset about a large bill she thought insurance should have covered. I reviewed the claim and found it had been denied because the insurer had outdated coordination of benefits information. I explained this, helped her update it with the insurer, and resubmitted the claim. It was paid, and she was very relieved.
- 16
Tell me about a time you managed a large backlog.
After a system change, we had a backlog of unbilled claims. I sorted them by payer deadline and value, worked the most urgent first and set daily targets. I also identified a recurring charge entry error causing many of the holds and had it fixed. We cleared the backlog within three weeks without missing any filing deadlines.
Situational medical biller and coder interview questions4 questions
- 17
What would you do if a provider asked you to code a service at a higher level than the documentation supported?
I would explain respectfully that I can only code what the documentation supports, because upcoding creates compliance and legal risk for the provider and practice. I would show what documentation would be needed for the higher level and offer to share the guidelines. If the pressure continued, I would raise it with the practice manager or compliance officer.
- 18
What would you do if you were unsure which code to use?
I would check the official guidelines, coding references and payer policies, and look at how similar cases were coded. If it was still unclear, I would ask a senior coder or send a query to the provider for clarification. I would not guess, because an incorrect code can lead to denials or compliance problems.
- 19
What would you do if a payer kept denying claims you believed were correct?
I would appeal with clear supporting documentation and reference the payer's own policies. I would track the denials to show the pattern, then contact the payer's provider relations team to resolve the underlying issue. If needed, I would escalate through the practice manager. Persistent wrong denials usually point to a payer setup or policy problem.
- 20
What would you do if you discovered a billing error that resulted in an overpayment?
I would report it to my supervisor and follow the practice's process for refunds, which includes returning overpayments to the payer or patient within required timeframes. Keeping money that was not owed creates compliance risk. I would also look at what caused the error, so it does not happen again.
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