30+ R1 RCM Senior Analyst Interview Questions and Answers

COBRA is a federal law that allows employees to continue their health insurance coverage after leaving their job. Copay is a fixed amount paid by the insured for each healthcare service. Deductibles are the amount the insured must pay out of pocket before the insurance company starts covering costs. HIPAA is a federal law that protects the privacy and security of patient health information.

• COBRA: Federal law for continuing health insurance after job loss

• Copay: Fixed amount pa...read more

There are 7 steps in revenue cycle management: Pre-authorization, Patient registration, Charge capture, Claim submission, Payment posting, Denial management, and Reporting.

• Pre-authorization: Obtaining approval from insurance companies before providing services.

• Patient registration: Collecting patient information and insurance details.

• Charge capture: Recording services provided and creating charges for billing.

• Claim submission: Submitting claims to insurance companies for reim...read more

An analyst is responsible for collecting, analyzing, and interpreting data to provide insights and recommendations to improve business performance.

• Collecting and organizing data from various sources

• Analyzing data using statistical methods and software

• Interpreting data to identify trends, patterns, and insights

• Developing reports and presentations to communicate findings and recommendations

• Collaborating with stakeholders to understand business needs and goals

• Continuously monito...read more

Timely filing denial is calculated from the date of service.

• Timely filing denial is calculated based on the date of service provided on the claim.

• Insurance companies have specific time frames within which claims must be submitted after the date of service.

• If a claim is submitted after the timely filing deadline, it may be denied for timely filing.

• Timely filing deadlines can vary depending on the insurance company and type of insurance plan.

• It is important for providers to be ...read more

CPT codes are used to identify medical procedures and services, while diagnosis codes are used to identify medical conditions.

• CPT codes are five-digit numeric codes that describe medical procedures and services.

• Diagnosis codes are alphanumeric codes that identify medical conditions.

• CPT codes and diagnosis codes are used together to bill insurance companies for medical services.

• Examples of CPT codes include 99213 for a standard office visit and 45378 for a colonoscopy.

• Examples...read more

Authorization dental is the process of obtaining approval from a dental insurance provider before receiving certain dental treatments.

• Authorization dental is required for certain procedures like crowns, bridges, and orthodontic treatments.

• The process involves submitting a treatment plan to the insurance company for review and approval.

• On-call scenario: A patient calls the dental office requesting a procedure that requires authorization. The office staff informs the patient th...read more

Co-pay is a fixed amount paid by the patient for a covered service, co-insurance is a percentage of costs shared between patient and insurer, deductible is the amount patient pays before insurance kicks in, out of pocket is the total amount patient pays for covered services.

• Co-pay is a set amount paid by the patient for each covered service, such as $20 for a doctor's visit.

• Co-insurance is the percentage of costs shared between the patient and the insurance company, such as 8...read more

The End-to-End Revenue Cycle involves multiple steps from patient registration to payment collection.

• Patient registration and scheduling

• Insurance verification and authorization

• Charge capture and coding

• Claim submission

• Payment posting and reconciliation

• Denial management and appeals

• Patient billing and collections

RCM stands for Revenue Cycle Management, which is the process of managing the financial aspects of healthcare services.

• RCM involves managing patient registration, insurance verification, coding and billing, and collections.

• It helps healthcare providers optimize their revenue and improve cash flow.

• RCM also ensures compliance with regulations and reduces the risk of errors and fraud.

• Examples of RCM software include Epic Systems, Cerner, and Allscripts.

There are two parts in dedicate: de and dicate. De means down or away, and dicate means to say or speak.

• De means down or away

• Dicate means to say or speak

Modified refers to changes made to something to improve its functionality or performance.

• Modification can involve altering existing features or adding new ones

• It is important because it allows for continuous improvement and adaptation to changing needs

• In software development, modified code is often used to fix bugs or add new functionality

PR stands for Public Relations, which is the practice of managing communication between an organization and its publics.

• Public Relations (PR) is the strategic communication process that builds mutually beneficial relationships between organizations and their publics.

• Types of PR include media relations, crisis communication, internal communication, community relations, and investor relations.

• Examples of PR activities include press releases, social media management, event plann...read more

Cobra, copay, and deduction are terms related to healthcare insurance.

• COBRA stands for Consolidated Omnibus Budget Reconciliation Act and allows employees to continue their health insurance coverage after leaving their job.

• Copay is a fixed amount paid by the patient for a covered healthcare service, while the insurance company pays the rest.

• Deduction is the amount of money that is subtracted from an employee's paycheck to pay for their health insurance premium.

Modifier 76 is used for repeat procedures by the same physician on the same day. Modifier 77 is used for repeat procedures by a different physician on the same day.

• Modifier 76 is used to indicate that a procedure or service was repeated by the same physician on the same day.

• Modifier 77 is used to indicate that a procedure or service was repeated by a different physician on the same day.

• These modifiers are used to distinguish between separate procedures performed on the same d...read more

There are three main types of Federal Insurance: Medicare, Medicaid, and Social Security Disability Insurance.

• Medicare provides health insurance 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 medical costs for some people with limited income and resources.

• Social Security Disability Insurance (SSDI) provides benefits to individuals who are unable to work due to a disability.

Dedicate eligibility refers to the qualifications or requirements needed to be considered for a dedicated position or task.

• Dedicate eligibility may include specific skills, experience, education, or certifications.

• For example, a Senior Analyst position may require a minimum of 5 years of relevant experience in the field.

• Eligibility criteria can vary depending on the organization and the nature of the role.

Non cover services can be handled by clearly communicating with clients, offering alternative solutions, and managing expectations.

• Clearly communicate with clients about the services that are not covered by their plan

• Offer alternative solutions or services that may be covered by their plan

• Manage client expectations by explaining the reasons for non-coverage and providing options for moving forward

Denial examples and coping strategies in a professional setting

• Acknowledge the denial and its impact on decision-making

• Seek feedback from colleagues or supervisors to gain perspective

• Practice self-reflection and identify any underlying fears or insecurities contributing to denial

• Develop a plan of action to address the issue causing denial

• Consider seeking support from a mentor or coach for guidance

Copy and coins is not a commonly used term. It may refer to a specific jargon in a particular industry.

• Copy and coins may refer to a specific term used in a particular industry, such as advertising or marketing.

• Without more context, it is difficult to provide a specific answer.

• It is possible that the interviewer may have misspoken or meant to ask a different question.

RCM process stands for Revenue Cycle Management, which involves managing the financial aspects of healthcare services.

• RCM process involves managing the financial aspects of healthcare services from patient registration to final payment.

• It includes tasks such as verifying insurance coverage, submitting claims, and following up on unpaid claims.

• Efficient RCM process helps healthcare organizations optimize revenue and improve cash flow.

• It also involves coding and billing complia...read more

Different payer types include government payers, commercial payers, and self-pay patients.

• Government payers: Medicare, Medicaid, TRICARE

• Commercial payers: Blue Cross Blue Shield, Aetna, Cigna

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

Timely filings refer to the submission of claims within a specific time frame.

• Insurance companies have specific deadlines for submitting claims

• Failing to submit claims within the deadline can result in denial of payment

• Timely filings vary depending on the type of insurance and the state

• For example, Medicare has a timely filing limit of one year from the date of service

US healthcare is a complex system that involves private and public insurance, healthcare providers, and government regulations.

• The US healthcare system is a mix of private and public insurance programs.

• Private insurance is typically provided by employers or purchased individually.

• Public insurance includes Medicare for seniors and Medicaid for low-income individuals.

• Healthcare providers include hospitals, clinics, and private practices.

• The government regulates healthcare throu...read more

Different types of insurance include health, life, auto, home, travel, pet, and liability insurance.

• Health insurance covers medical expenses and treatments.

• Life insurance provides financial support to beneficiaries in case of the policyholder's death.

• Auto insurance covers damages and injuries in case of a car accident.

• Home insurance covers damages to the house and personal belongings.

• Travel insurance covers unexpected events during travel, such as trip cancellation or medical...read more

I want to join r1rcm because of their reputation for providing excellent healthcare revenue cycle management services.

• R1RCM is known for their expertise in revenue cycle management

• I am impressed by their track record of helping healthcare organizations improve their financial performance

• I believe my skills and experience align well with the opportunities at r1rcm

Commercial insurance plan types include PPO, HMO, EPO, and POS.

• Preferred Provider Organization (PPO) - offers a network of healthcare providers and allows members to see out-of-network providers at a higher cost

• Health Maintenance Organization (HMO) - requires members to choose a primary care physician and get referrals for specialists

• Exclusive Provider Organization (EPO) - similar to a PPO but does not cover any out-of-network care

• Point of Service (POS) - combines features of...read more

Medicare eligibility refers to the criteria individuals must meet in order to qualify for Medicare benefits.

• Individuals aged 65 and older are typically eligible for Medicare

• Younger individuals with certain disabilities or medical conditions may also be eligible

• Medicare eligibility is also extended to individuals with end-stage renal disease (ESRD)

• Citizens or permanent residents of the United States are generally eligible for Medicare

Copay is a fixed amount paid by the patient for a covered healthcare service, while coinsurance is a percentage of the cost shared between the patient and the insurance company.

• Copay is a set amount paid by the patient at the time of service (e.g. $20 for a doctor's visit).

• Coinsurance is a percentage of the total cost of a covered service that the patient pays after meeting the deductible (e.g. 20% of the cost of a hospital stay).

• Both copay and coinsurance are forms of cost-s...read more

Denials can be categorized into different types based on the reason for denial.

• Medical necessity denials

• Coding denials

• Duplicate billing denials

• Timely filing denials

• Authorization denials

• Non-covered service denials

RCM stands for Revenue Cycle Management, which is the process of managing claims, payments, and revenue generation in healthcare. FCC stands for Federal Communications Commission, which regulates communications in the US.

• RCM involves managing patient billing, claims processing, and revenue generation in healthcare organizations.

• FCC regulates communications in the US, including radio, television, wire, satellite, and cable.

• Examples of RCM software include Epic Systems, Cerner,...read more

Yes

• I have extensive experience in US healthcare RCM (Revenue Cycle Management)

• I have worked with various healthcare organizations, managing their financial processes and optimizing revenue generation

• I am well-versed in medical coding, billing, claims processing, and reimbursement methodologies

• I have successfully implemented RCM strategies to improve cash flow, reduce denials, and enhance overall financial performance

• I have a strong understanding of healthcare regulations, suc...read more