17 Medical Reviewer Interview Questions and Answers

Medical reviewers are responsible for ensuring the accuracy of medical information in insurance claims. They work with insurance companies, healthcare providers, and patients to make sure that everyone has the most accurate information about a patient’s medical history.

If you’re looking for a job in the medical field, you may need to go through a medical reviewer interview. In this interview, you will be asked questions about your medical knowledge and experience. You will also be asked questions about your experience with insurance and healthcare.

To help you prepare for your interview, we have put together a list of common medical reviewer interview questions and answers.

Are you familiar with the standards and regulations that apply to medical records?

Interviewers may ask this question to assess your knowledge of the Health Insurance Portability and Accountability Act (HIPAA) and other regulations that apply to medical records. They want to make sure you understand how to handle confidential information, such as patient names and addresses, and how to maintain accurate records. In your answer, explain what steps you take to ensure compliance with these standards and regulations.

Example: “I am very familiar with HIPAA regulations because I have worked in a hospital setting for several years. As part of my daily routine, I always check with patients before releasing their medical records. If they are not ready to release them, I will wait until they feel comfortable doing so. I also keep all identifying information private by using initials or pseudonyms when recording symptoms and treatments.”

What are some of the most important qualities for a medical reviewer?

Interviewers may ask this question to learn more about your personality and how you would fit in with their team. They want to know that you have the skills, knowledge and experience needed for the role but also that you are a good communicator who can work well with others. When preparing your answer, think of some of the most important qualities you possess and relate them back to the job description.

Example: “I believe that one of the most important qualities for a medical reviewer is attention to detail. I am very organized and methodical when it comes to my work, so I always make sure to read through all documents carefully before making any decisions. Another quality I feel is important is communication. As a medical reviewer, we often need to collaborate with other reviewers and physicians on cases. I enjoy speaking with others and explaining my reasoning behind my decisions.”

How would you approach reviewing a physician’s record if you noticed they were prescribing the same treatment for a condition repeatedly?

This question can help interviewers understand how you would handle a situation that could be considered unethical. Your answer should show your commitment to upholding the standards of medical ethics and explain why this is important.

Example: “I have seen this happen in my previous role as a medical reviewer, and I always approach it with caution. If the treatment was prescribed for a legitimate reason, such as if the patient’s condition changed or they were taking other medications that affected their symptoms, then there is no issue. However, if the physician did not provide an explanation, I would contact them to discuss the matter further. In some cases, we may need to take action against the physician, which can be difficult but necessary.”

What is your process for approaching a physician about a negative review if they are already defensive?

This question can help interviewers understand how you handle conflict and whether you have the ability to diffuse a situation. Your answer should show that you are willing to approach physicians about negative reviews, even if they’re defensive or disagree with your assessment.

Example: “I would first explain my reasoning for giving them a low rating. If they still disagreed with my review, I would ask them what specific information they feel is missing from their profile. This helps me learn more about their practice so I can provide more accurate feedback in the future. It also shows them that I am committed to providing quality reviews.”

Provide an example of a time you identified a problem with a physician’s record keeping and explain your approach for approaching them about the issue.

Interviewers may ask this question to learn more about your communication skills and how you approach challenging situations. In your answer, try to highlight your problem-solving abilities and willingness to speak up when necessary.

Example: “In my last position as a medical reviewer, I noticed that one of the physicians in the hospital was missing some important information on their patient records. When I approached them about it, they told me they were aware of the issue but had been too busy to fix it. I offered to help them find time during their schedule to update the records so they could avoid any potential issues with patients. They agreed, and we scheduled an hour each week for them to go through all of their old records and make sure everything was accurate.”

If a physician disagreed with your assessment of their record keeping, how would you approach the situation to maintain a professional relationship?

Interviewers may ask this question to assess your interpersonal skills and ability to work with others. When answering, it can be helpful to mention a specific example of how you handled the situation successfully in the past.

Example: “In my experience as a medical reviewer, I have encountered physicians who disagree with my assessment of their record keeping. In these situations, I try to remain professional and explain why I made the decision that I did. If they still disagree, I offer them an opportunity to discuss the matter further with my supervisor or another senior member of our team.”

What would you do if a physician’s record keeping caused a patient to experience complications or an adverse reaction to a treatment?

Medical reviewers are responsible for ensuring that physicians keep accurate records of their patients’ medical histories. This question helps the interviewer assess your ability to handle challenging situations and make decisions in a timely manner. In your answer, demonstrate how you would use critical thinking skills to solve this problem while protecting the physician’s reputation.

Example: “If I found that a physician’s record keeping caused an adverse reaction or complications with a patient, I would first determine if there was any way to reverse the situation. If not, I would contact the physician immediately and ask them to explain what happened. Then, I would work with the physician to develop a plan to ensure they maintain their license and avoid future problems.”

How well do you think you would get along with a physician if you were asked to review their records?

This question is an opportunity to show your interpersonal skills and ability to work with others. It’s important that medical reviewers have good communication skills, so it can be beneficial if you highlight how well you would get along with a physician during this interview.

Example: “I think I would do quite well getting along with a physician because of my strong communication skills. I am always respectful when speaking with others, and I believe that I could help physicians understand why their records were rejected by the state. I also feel like I would be able to explain what they need to improve on in order to pass their next review.”

Do you have experience reviewing the records of other healthcare professionals in addition to physicians?

This question can help interviewers understand your experience with reviewing medical records and how you might approach the work of a medical reviewer. If you have experience reviewing other healthcare professionals’ records, consider describing what that process was like.

Example: “I’ve reviewed the records of nurses, physician assistants and other physicians in my role as a medical reviewer for three years now. I find it helpful to review all types of medical records because it helps me get a better understanding of each patient’s care plan. For example, when I’m reviewing a physician’s record, I look at their diagnosis, treatment plans and progress notes. When I’m reviewing a nurse’s or PA’s record, I focus more on their assessment and observations.”

When reviewing a physician’s record keeping, what would you do if you noticed they had made a clerical error?

This question is an opportunity to show your attention to detail and ability to work independently. When answering, it can be helpful to mention a specific example of when you noticed a clerical error in a physician’s record keeping and how you handled the situation.

Example: “When reviewing a physician’s record keeping, I would first make sure that the mistake was not due to my own clerical error. If there was no doubt that the physician had made a clerical error, I would contact them directly and ask if they could provide me with additional information or documentation to support their claim. If they were unable to do so, I would then notify the medical review board about the clerical error and request guidance on what action to take next.”

We want to improve our compliance with HIPAA standards. How would you approach this as a medical reviewer?

HIPAA is a set of standards that healthcare providers must follow to protect the privacy and security of their patients’ medical records. An interviewer may ask you this question to see how you would apply your knowledge of HIPAA to improve compliance in their organization. In your answer, explain what steps you would take to ensure the organization’s compliance with HIPAA standards.

Example: “I would first make sure all employees understand the importance of maintaining patient confidentiality. I would also regularly review our policies and procedures for handling confidential information and train staff on these processes. Finally, I would conduct regular audits to ensure we are following HIPAA guidelines.”

Describe your process for approaching a physician about their patient’s satisfaction with their care.

This question is a great way to assess your interpersonal skills and ability to work with others. When answering this question, it can be helpful to describe the steps you take when approaching someone about their patient’s care and how you use your communication skills to help them improve their practice.

Example: “I approach physicians about their patients’ satisfaction with their care by first asking them what they think of their overall performance. I then ask them if there are any areas where they would like to improve or change. If they have no suggestions for improvement, I will offer some ideas that may help them better serve their patients. For example, I might suggest they add more staff members to reduce wait times or provide additional resources to educate patients on common conditions.”

What makes you a good fit for reviewing medical records?

This question can help the interviewer determine if you have the skills and qualifications to succeed in this role. Use your answer to highlight your critical thinking, communication and organizational skills. You may also want to mention any experience reviewing medical records or other professional experience that relates to this job.

Example: “I am a strong communicator who is able to work with many different types of people. I enjoy helping others understand complex information and find solutions to problems. My ability to think critically and solve problems makes me well-suited for this role. I am also highly organized and detail-oriented, which helps me stay on top of my work. In addition, I have previous experience as a medical record reviewer.”

Which types of medical records do you have the most experience reviewing?

This question can help the interviewer determine your level of experience and expertise in reviewing medical records. It can also show them what types of records you’re comfortable with, which may be important if they need someone who is familiar with a specific type of record. When answering this question, it can be helpful to mention any certifications or training you have that relates to the type of record you’ve reviewed most often.

Example: “I have the most experience reviewing patient charts for hospital patients. I worked as an assistant reviewer at my last job where I helped review patient charts from multiple hospitals. This gave me valuable experience working with different types of charts and learning how to read them effectively.”

What do you think is the most important aspect of medical record keeping?

This question is an opportunity to show your interviewer that you understand the importance of medical record keeping and how it can affect patient care. Your answer should include a specific example from your experience as a medical records keeper.

Example: “I think the most important aspect of medical record keeping is accuracy. If I make a mistake in my notes, it could lead to misdiagnosis or improper treatment for patients. In my last position, I was responsible for entering all patient information into our electronic medical records system. One day, I noticed one of my colleagues had entered incorrect information about a patient’s allergies. I immediately notified her so she could correct the error before the doctor saw it.”

How often do you think physicians should update their records?

Medical reviewers often need to know how frequently physicians update their records. This information helps them determine whether a physician’s record is up-to-date and accurate. When answering this question, it can be helpful to mention the frequency you think is best for keeping medical records current.

Example: “I believe that physicians should update their records at least once every three months. I’ve seen instances where physicians haven’t updated their records in over a year, which makes it difficult for medical reviewers to accurately assess their work. If a physician hasn’t updated their records in a while, I would recommend they do so as soon as possible.”

There is a discrepancy between the physician’s record keeping and the patient’s recollection of their treatment. How would you approach the situation?

This question is designed to assess your ability to handle challenging situations and make decisions that are in the best interest of the patient. Your answer should demonstrate your problem-solving skills, critical thinking abilities and empathy for patients.

Example: “I would first ask the patient what they remember about their treatment. I would then speak with the physician who wrote the record keeping to get their recollection of the situation. If there is still a discrepancy between the two accounts, I would contact the hospital’s medical records department to see if there is any additional information available from the medical charts.

If all else fails, I would call the patient back and explain that we cannot find an explanation for the discrepancy. I would apologize for the inconvenience and offer them a free follow-up visit as compensation.”