Review the evidence signals before interviewing. Then use the anchored descriptions—not instinct alone—to choose the score that best matches each answer.
01
Evaluation factor
Execution and reliability
35% weight
Check daily claim volume handled, clearinghouse and PM systems used (Availity, Kareo, Epic, AdvancedMD), CPT/ICD-10 and modifier accuracy, plus clean claim rate and AR days.
Evidence to listen for
Describes a workload they owned and how they kept it from slipping
Names the tools and systems they ran day to day
Can talk about volume: tickets, inboxes, orders, uptime
Nothing quietly falls through when they are busy
Five-point scoring guide
1
Poor
Cannot describe their own workload; things slip without them noticing.
2
Needs Improvement
Handles routine volume; drops work under pressure.
3
Satisfactory
Reliable on steady-state work; struggles when volume spikes.
4
Very Good
Consistently reliable at real volume with a system for staying on top.
5
Excellent
Cites claims processed per day, first-pass acceptance above 95 percent, and names specific payer portals and practice management systems used.
02
Evaluation factor
Improving the process
25% weight
Probe changes they made to reduce denials: worklist triage rules, eligibility checks before visits, superbill templates, or aging report cadence that shortened AR over 90 days.
Evidence to listen for
Has changed a process rather than only following one
Can name what was slow or error-prone and what they did about it
Documents so the improvement survives them
Knows when a process is worth automating and when it is not
Five-point scoring guide
1
Poor
Follows instructions only; no sense that process can change.
2
Needs Improvement
Notices problems but escalates rather than solving.
3
Satisfactory
Makes small improvements; impact is local and undocumented.
4
Very Good
Has redesigned a real process with measurable effect.
5
Excellent
Describes a concrete fix, such as front-end eligibility verification, with before and after denial or AR aging numbers attached.
03
Evaluation factor
Judgement and autonomy
25% weight
Assess how they handle a CO-16 or CO-97 denial, an underpayment versus contracted rate, patient balance disputes, and when to escalate to the coder or provider.
Evidence to listen for
Knows what to decide alone and what to escalate
Handles an exception without freezing or improvising recklessly
Protects confidentiality and access appropriately
Asks a clarifying question rather than guessing on something costly
Five-point scoring guide
1
Poor
Either escalates everything or acts recklessly on their own.
2
Needs Improvement
Needs frequent direction; uneasy with exceptions.
3
Satisfactory
Sound judgement on familiar decisions.
4
Very Good
Clear sense of their own authority; handles exceptions well.
5
Excellent
Distinguishes rebill, appeal, and write-off decisions confidently, knows appeal deadlines, and escalates coding questions rather than guessing modifiers.
04
Evaluation factor
Communication
15% weight
Judge how they explain an EOB or unexpected balance to an upset patient, chase payer reps for claim status, and document HIPAA-safe notes in the account.
Evidence to listen for
Writes clearly enough that people act without a follow-up
Manages expectations before a deadline slips, not after
Handles a frustrated colleague or customer calmly
Works across time zones or async where the role needs it
Five-point scoring guide
1
Poor
Unclear written communication; goes quiet when things slip.
2
Needs Improvement
Communication needs chasing; raises problems late.
3
Satisfactory
Clear enough day to day; proactive updates are inconsistent.
4
Very Good
Clear, proactive, and calm under pressure.
5
Excellent
Explains coinsurance and deductible plainly without jargon, keeps clear account notes with reference numbers, and stays composed on collections calls.
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