Tell us about a time when you had to handle a billing or insurance error. How did you identify and rectify the mistake?

In my previous role as a medical scheduler, I encountered a billing error when a patient's insurance claim was denied. To identify the mistake, I first reviewed the patient's insurance information and compared it to the claim details. I discovered that the patient had recently switched insurance providers, but the updated information was not correctly updated in the system. To rectify the error, I contacted the patient to inform them of the issue and requested the updated insurance information. Once I received the updated details, I updated the patient's profile in the scheduling software and resubmitted the claim with the accurate information. The claim was successfully processed, and the patient's appointment was rescheduled without any further complications.

I had a situation as a medical scheduler where a patient's insurance claim was denied due to a billing error. To identify the mistake, I carefully reviewed the patient's insurance details and compared them to the claim. I noticed that the patient's policy number was entered incorrectly in the system, leading to the denial. In order to rectify the error, I contacted the patient and explained the issue. I requested the correct policy number from the patient and updated it in the system. I also double-checked other billing information to ensure accuracy. Once everything was corrected, I resubmitted the claim, providing the accurate information. As a result, the claim was processed successfully. To prevent similar errors in the future, I implemented a double-check process for entering insurance details into the system. This involved cross-referencing the information provided by patients with the insurance cards to ensure accuracy. This additional step helped minimize billing errors and improved efficiency in claim processing.

During my time as a medical scheduler, I encountered a billing error that required careful handling. A patient received an unexpectedly high bill for a procedure, and upon investigation, I discovered that the insurance company had incorrectly categorized the procedure as cosmetic instead of medically necessary. To rectify this error, I assembled a documentation package that included the patient's medical records, a letter of medical necessity from the referring physician, and supporting research articles. I then contacted the insurance company and engaged in a detailed discussion with their claims department. I clearly explained the situation, provided the necessary documentation, and advocated for the correct categorization of the procedure. Through effective communication and persistence, I successfully convinced the insurance company to reevaluate the claim. The procedure was subsequently recognized as medically necessary, and the patient's bill was adjusted accordingly. To prevent similar errors in the future, I initiated regular audits of procedure codes and billing documentation to ensure alignment with insurance policies and guidelines. This proactive approach helped identify and rectify potential errors before they impacted patients and improved overall billing accuracy.