40+ Blue Rose Technologies Interview Questions and Answers

Handling authorization cases in AR calling

• Verify the patient's insurance coverage and benefits

• Obtain necessary authorizations from insurance companies

• Document all communication and authorization details

• Follow up with insurance companies to ensure timely approvals

• Educate patients on their financial responsibilities and options

• Escalate unresolved authorization issues to supervisors or managers

Explanation of denials and their fixes

• Denial: Lack of documentation. Fix: Ensure all necessary documentation is complete and accurate.

• Denial: Coding errors. Fix: Review and correct any coding errors to ensure accurate billing.

• Denial: Timely filing limit exceeded. Fix: Submit claims within the specified time frame.

• Denial: Duplicate claims. Fix: Implement processes to prevent duplicate submissions.

• Denial: Medical necessity not met. Fix: Provide additional documentation to suppo...read more

The role of a quality auditor in addressing a user consistently making errors and not accepting them.

• Provide additional training or resources to help the user improve their skills

• Offer constructive feedback and guidance on how to avoid errors in the future

• Implement a system for monitoring and tracking errors to identify patterns and areas for improvement

• Encourage open communication and collaboration to address any underlying issues causing the errors

• Consider involving a super...read more

CMS 100 is a medical claim form used for billing purposes.

• CMS 100 has 33 columns

• It includes patient information, provider information, and billing codes

• Some of the columns include patient name, date of birth, diagnosis codes, and procedure codes

Pre-authorization is a process of obtaining approval from an insurance company before providing medical services. Crossover is a process of billing a secondary insurance provider after the primary insurance provider has paid their portion. COB stands for Coordination of Benefits and is the process of determining which insurance provider is responsible for paying for a patient's medical expenses when they have multiple insurance policies.

• Pre-authorization is obtaining approval...read more

Focused sampling involves selecting specific areas or items for inspection based on predetermined criteria, while normal sampling involves randomly selecting items for inspection.

• Focused sampling is used when specific areas or items need more attention or have higher risk

• Normal sampling is used when all items have equal chance of being selected for inspection

• Example of focused sampling: Inspecting high-risk components in a manufacturing process

• Example of normal sampling: Rand...read more

Implementing proactive measures and effective communication to minimize absenteeism impact on client delivery.

• Implement a clear attendance policy with consequences for excessive absenteeism

• Provide incentives for good attendance such as rewards or recognition

• Cross-train team members to ensure coverage in case of absences

• Encourage open communication between team members to facilitate shift swaps or coverage

• Utilize technology for remote work options or flexible scheduling

Denial in Revenue Cycle Management (RCM) refers to the rejection of a claim for reimbursement by a payer.

• Denials can occur for various reasons such as incorrect patient information, lack of pre-authorization, coding errors, or exceeding the coverage limit.

• Analyzing denial trends can help identify areas for improvement in the revenue cycle process.

• Effective denial management involves appealing denied claims, correcting errors, and preventing future denials.

• Examples of denials ...read more

Key Result Areas (KRA's) of an auditor include evaluating financial statements, ensuring compliance with regulations, and identifying areas for improvement.

• Evaluating financial statements to ensure accuracy and compliance

• Ensuring compliance with regulations and internal policies

• Identifying areas for improvement in processes and controls

• Communicating findings and recommendations to management

• Conducting risk assessments and internal audits

• Developing audit plans and procedures

• Fo...read more

Feedback should be constructive, specific, and delivered in a respectful manner.

• Start with positive feedback before addressing areas for improvement

• Be specific about what the user did well and what needs improvement

• Use 'I' statements to avoid sounding accusatory

• Provide actionable suggestions for improvement

• Encourage open communication and ask for the user's perspective

• Follow up to see if the feedback was helpful and if any progress has been made

Common denials in revenue cycle management include lack of pre-authorization, coding errors, timely filing limits, duplicate billing, and non-covered services.

• Lack of pre-authorization for services

• Coding errors leading to claim denials

• Exceeding timely filing limits for claims submission

• Duplicate billing for the same service

• Services not covered by insurance

A deposit is a sum of money placed in a bank account or given as security for a rental or purchase.

• A deposit is a financial transaction where money is placed into a bank account.

• It can also refer to a sum of money given as security for a rental property or purchase.

• Deposits can be made in cash, check, or electronically.

• Deposits are often required when opening a new bank account or renting an apartment.

• Deposits can earn interest over time, depending on the type of account.

Common denials in operations include lack of documentation, incorrect coding, eligibility issues, timely filing limits, and duplicate claims.

• Lack of documentation (e.g. missing or incomplete medical records)

• Incorrect coding (e.g. using incorrect procedure or diagnosis codes)

• Eligibility issues (e.g. patient not covered by insurance or policy limitations)

• Timely filing limits (e.g. claims not submitted within specified time frame)

• Duplicate claims (e.g. submitting the same claim ...read more

The 7 QC tools are basic tools used in quality control to analyze and solve problems.

• Check sheet: Used to collect and organize data

• Histogram: Represents data distribution visually

• Pareto chart: Shows the most significant factors in a process

• Cause and effect diagram (Fishbone diagram): Identifies root causes of a problem

• Scatter diagram: Shows the relationship between two variables

• Control chart: Monitors process performance over time

• Flow chart: Represents the sequence of steps i...read more

The Pacific is the largest and deepest ocean on Earth.

• It covers one-third of the Earth's surface

• It has an average depth of 12,080 feet

• It is home to a diverse range of marine life, including whales, dolphins, sharks, and sea turtles

• It is bordered by Asia, Australia, North and South America, and Antarctica

• It is known for its many islands, including Hawaii, Fiji, and Tahiti

Pacific Healthcare is a leading healthcare provider in the region.

• Pacific Healthcare offers a wide range of medical services including primary care, specialty care, and surgical procedures.

• They have state-of-the-art facilities and a team of highly skilled healthcare professionals.

• Pacific Healthcare is known for their commitment to patient care and quality service.

• They have multiple locations across the region to serve a large patient population.

I have a strong software knowledge with expertise in various programming languages and tools.

• Proficient in programming languages such as Java, Python, and C++

• Experience with software development tools like Git, Jira, and Jenkins

• Familiarity with database management systems such as MySQL and MongoDB

• Knowledge of software design patterns and best practices

• Ability to troubleshoot and debug complex software issues

Referral is a recommendation for a service or treatment, while authorization is permission from an insurance company to receive that service or treatment.

• Referral is a recommendation from a primary care physician to see a specialist or receive a specific service.

• Authorization is permission from an insurance company to receive that service or treatment.

• Referral is typically required before authorization can be obtained.

• For example, a patient may need a referral from their prim...read more

Common denial tactics used regularly

• Deflection - shifting blame or responsibility onto someone or something else

• Minimization - downplaying the significance or impact of a situation

• Rationalization - providing seemingly logical reasons to justify behavior

• Gaslighting - manipulating someone into questioning their own reality

• Projection - attributing one's own negative traits or actions onto others

Capitation is a payment arrangement in healthcare where a provider is paid a fixed amount per patient regardless of the services provided.

• Capitation involves a fixed payment per patient per period of time, regardless of the actual services provided.

• Providers are incentivized to keep costs low and quality high to maximize profits.

• It shifts the financial risk from the payer to the provider.

• Examples include HMOs and managed care organizations that use capitation to control costs...read more

Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services provided by a healthcare provider.

• Involves submitting claims to insurance companies for services rendered

• Ensures accurate coding of procedures and diagnoses

• Follows up on claims to ensure timely payment

• Handles patient billing inquiries and disputes

• Plays a crucial role in revenue cycle management for healthcare providers

RCM work process refers to the steps involved in revenue cycle management, from patient registration to claim submission and payment collection.

• Patient registration and insurance verification

• Coding and charge capture

• Claim submission to insurance companies

• Payment posting and denial management

• Follow-up on unpaid claims and patient balances

• Reporting and analysis for process improvement

QMB or Dual plan refers to a type of Medicare Advantage plan that offers additional coverage beyond traditional Medicare.

• QMB stands for Qualified Medicare Beneficiary

• Dual plan refers to a plan for individuals who are eligible for both Medicare and Medicaid

• These plans provide extra benefits such as dental, vision, and prescription drug coverage

• QMB plans help cover Medicare premiums, deductibles, and coinsurance for low-income individuals

Extract connection imports data into Tableau workbook while live connection directly connects to data source.

• Extract connection creates a static snapshot of data in Tableau workbook.

• Live connection directly queries data from the source in real-time.

• Extract connection is useful for large datasets or when offline access is needed.

• Live connection is beneficial for real-time data analysis and dynamic updates.

• Example: Extract connection for monthly sales reports, live connection f...read more

Medicare and Medicaid are government-sponsored healthcare programs in the United States.

• Medicare is a federal health insurance program primarily for people aged 65 and older, as well as certain younger individuals with disabilities.

• Medicaid is a joint federal and state program that helps with healthcare costs for people with limited income and resources.

• Medicare is divided into different parts such as Part A (hospital insurance) and Part B (medical insurance), while Medicaid ...read more

DPU stands for Defects Per Unit and DPO stands for Defects Per Opportunity. They are key metrics used in quality management.

• DPU measures the average number of defects in a product or process

• DPO measures the average number of opportunities for defects in a product or process

• DPU = Total number of defects / Total units produced

• DPO = Total number of defects / Total opportunities for defects

There are various types of payers in the US healthcare system, including private insurance companies, government programs like Medicare and Medicaid, and self-pay patients.

• Private insurance companies: Offered through employers or purchased individually, such as Blue Cross Blue Shield or Aetna.

• Government programs: Medicare for seniors and Medicaid for low-income individuals and families.

• Self-pay patients: Individuals who pay for healthcare services out of pocket.

• Managed care o...read more

A modifier is a code used in medical billing to indicate that a service or procedure has been altered in some way.

• Modifiers are two-digit codes added to a CPT or HCPCS code to provide additional information about the service provided.

• Modifiers can affect reimbursement rates, indicate that multiple procedures were performed, or specify the location or time of the service.

• For example, modifier 50 is used to indicate a bilateral procedure, while modifier 25 is used to indicate a...read more

COVID-19 is a highly infectious respiratory illness caused by the novel coronavirus.

• It originated in Wuhan, China in December 2019

• Symptoms include fever, cough, and difficulty breathing

• It spreads through respiratory droplets when an infected person talks, coughs, or sneezes

• Prevention measures include wearing masks, social distancing, and frequent hand washing

• Vaccines have been developed and are being distributed globally

Credentialing is the process of verifying and evaluating the qualifications and credentials of individuals or organizations.

• Credentialing is commonly used in industries such as healthcare, education, and professional services.

• It involves verifying and assessing the qualifications, experience, and background of individuals or organizations.

• The process typically includes verifying education, training, licensure, certifications, work history, and other relevant credentials.

• Crede...read more

I have extensive experience in healthcare management, including managing medical billing and coding processes.

• Managed medical billing and coding processes for a large healthcare organization

• Developed and implemented policies and procedures to ensure compliance with healthcare regulations

• Collaborated with healthcare providers to improve patient care and outcomes

• Analyzed healthcare data to identify trends and opportunities for improvement

HMO and PPO are types of health insurance plans.

• HMO stands for Health Maintenance Organization, which typically requires members to choose a primary care physician and get referrals for specialists.

• PPO stands for Preferred Provider Organization, which allows members to see any healthcare provider without a referral, but offers lower costs for using in-network providers.

• HMO plans usually have lower premiums and out-of-pocket costs, but less flexibility in choosing healthcare p...read more

New and Old CPT codes are used in medical billing to describe medical procedures and services.

• New CPT codes are added every year to reflect new medical procedures and technologies.

• Old CPT codes may become obsolete or replaced by new codes.

• It is important for AR callers to stay updated on new and old CPT codes to ensure accurate billing and reimbursement.

• Example: CPT code 99213 (office visit) was replaced by 99214 in 2021.

• Example: CPT code 90834 (psychotherapy) was replaced by...read more

Technical accounting definition refers to the specific rules and guidelines that govern the preparation of financial statements.

• Technical accounting involves following Generally Accepted Accounting Principles (GAAP)

• It includes rules for recording transactions, preparing financial statements, and disclosing information

• Examples of technical accounting standards include revenue recognition, lease accounting, and inventory valuation

Tableau offers various types of filters including quick filters, context filters, and data source filters.

• Quick filters allow users to easily filter data by selecting values from a list.

• Context filters are applied before other filters, affecting the data visible to subsequent filters.

• Data source filters limit the data available to Tableau by filtering data at the data source level.

• Other types of filters include extract filters, top N filters, and relative date filters.

There are two types of refresh in Tableau: Extract Refresh and Data Source Refresh.

• Extract Refresh: Refreshes the data in Tableau extract, which is a snapshot of data from the original data source.

• Data Source Refresh: Refreshes the data directly from the original data source.

• Examples: Extract Refresh is useful when working with large datasets to improve performance, while Data Source Refresh ensures real-time data updates.

Sepsis is a life-threatening condition caused by the body's response to an infection, leading to organ dysfunction.

• Sepsis occurs when the body's immune system overreacts to an infection, causing widespread inflammation.

• Symptoms of sepsis include fever, rapid heart rate, rapid breathing, and confusion.

• Severe cases of sepsis can lead to septic shock, which is a medical emergency requiring immediate treatment.

• Early recognition and prompt treatment of sepsis are crucial for impro...read more

I work with various tax IDs including federal tax ID numbers, state tax IDs, and local tax IDs.

• I am familiar with obtaining and verifying tax IDs from customers and vendors

• I ensure that tax IDs are accurately recorded in our systems for tax reporting purposes

• I work closely with the finance and accounting teams to ensure compliance with tax regulations

Ruled out refers to conditions or diagnoses that have been considered but ultimately determined not to be present in a patient.

• Ruled out conditions are often listed in a patient's medical record to document the thought process behind the diagnosis.

• It is important for medical coders to accurately reflect ruled out conditions in coding to ensure proper reimbursement.

• For example, if a patient presents with chest pain but further testing rules out a heart attack, the coder would ...read more

Radiology is a branch of medicine that uses imaging techniques such as X-rays, CT scans, and MRIs to diagnose and treat diseases.

• Radiology involves the use of various imaging techniques to visualize the inside of the body

• Common imaging techniques used in radiology include X-rays, CT scans, MRIs, and ultrasounds

• Radiologists interpret the images produced by these techniques to diagnose and treat medical conditions

• Radiology plays a crucial role in detecting and monitoring diseas...read more

Five common reasons for denial in accounts receivable analysis.

• Incorrect patient information

• Lack of pre-authorization

• Coding errors

• Non-covered services

• Timely filing limits exceeded