10+ Benefit Analyst Interview Questions and Answers

HIPAA Act is a US law that protects sensitive patient health information.

• HIPAA stands for Health Insurance Portability and Accountability Act

• It sets national standards to protect individuals' medical records and other personal health information

• HIPAA ensures the confidentiality, integrity, and availability of protected health information

• It also gives patients more control over their health information and sets boundaries on the use and release of health records

Embedded plan and aggregate plan are two types of benefit plans offered by employers.

• Embedded plan refers to a benefit plan where each employee has their own individual plan within a group plan.

• Aggregate plan refers to a benefit plan where all employees are covered under a single plan.

• The main difference is that in an embedded plan, each employee has their own unique plan details, while in an aggregate plan, all employees have the same plan.

• Embedded plans are more customizabl...read more

Timely filing limit is the deadline by which a claim must be submitted to an insurance company for reimbursement.

• Timely filing limit varies by insurance company and can range from 90 days to one year.

• Claims submitted after the timely filing limit may be denied by the insurance company.

• It is important for healthcare providers to submit claims within the timely filing limit to ensure reimbursement.

• For example, if an insurance company has a timely filing limit of 120 days, a hea...read more

Different types of member benefits include health insurance, retirement plans, paid time off, and wellness programs.

• Health insurance

• Retirement plans

• Paid time off

• Wellness programs

COB stands for Coordination of Benefits. It refers to the process of determining which insurance plan is primary and which is secondary when a patient is covered by multiple insurance plans.

• COB helps prevent overpayment by ensuring that the total amount paid by all insurance plans does not exceed the total cost of the claim.

• Types of COBs include non-duplication of benefits, traditional COB, and maintenance of benefits.

• Non-duplication of benefits means that the secondary plan ...read more

Claims adjudication process is the evaluation of a claim to determine its validity and payment amount.

• Claims are submitted by healthcare providers for services rendered to patients.

• The claim is reviewed by the insurance company to ensure it meets coverage criteria.

• Adjudication involves verifying the patient's eligibility, the provider's credentials, and the service's necessity.

• The claim is then processed and a payment amount is determined based on the insurance policy.

• If the ...read more

RCM stands for Revenue Cycle Management, which is the process of managing claims, payments, and revenue generation in healthcare organizations.

• RCM involves tracking a patient's journey from scheduling an appointment to receiving payment for services rendered.

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

• Efficient RCM can help healthcare organizations improve cash flow and reduce denials.

• Examples of RCM software include Epic Sys...read more

HMO and PPO plans are types of health insurance plans that differ in terms of network coverage and cost-sharing.

• HMO (Health Maintenance Organization) plans require members to choose a primary care physician and get referrals to see specialists.

• PPO (Preferred Provider Organization) plans offer more flexibility in choosing healthcare providers and do not require referrals to see specialists.

• HMO plans typically have lower out-of-pocket costs but limited provider networks, while ...read more

Yes, HMO typically requires a referral for specialist care.

• HMO plans usually require a primary care physician (PCP) referral for specialist visits.

• Referrals are needed to ensure that the care is medically necessary and cost-effective.

• Without a referral, the HMO may not cover the specialist visit or procedure.

• Some exceptions may apply for emergency situations or certain preventive services.