17 Provider Enrollment Specialist Interview Questions and Answers

A provider enrollment specialist is responsible for the credentialing and enrollment of healthcare providers in insurance plans. The specialist reviews applications, verifies provider qualifications, and submits complete applications to insurance companies.

The provider enrollment specialist position is a critical role in the healthcare industry. If you’re considering a career in this field, you will need to know how to answer provider enrollment specialist interview questions.

In this guide, you will find provider enrollment specialist interview questions and answers, as well as tips on how to prepare for your interview.

Are you familiar with the Affordable Care Act and how it affects provider enrollment?

The Affordable Care Act is a federal law that requires all Americans to have health insurance. It also outlines the requirements for providers and how they can enroll with Medicare. An interviewer may ask this question to see if you are familiar with the ACA and its regulations. In your answer, try to show that you understand the basics of the ACA and how it affects provider enrollment.

Example: “Yes, I am very familiar with the Affordable Care Act. As someone who has worked in healthcare for many years, I’ve seen firsthand how the ACA has changed the way providers work with Medicare. For example, before the ACA, providers could choose whether or not to accept Medicare patients. Now, they must accept them as long as they meet certain criteria.”

What are some of the most important things that providers need to know about their insurance coverage?

This question is an opportunity to show your knowledge of the insurance industry and how it works. It’s also a chance to demonstrate that you can help providers understand their coverage, which may be helpful in getting them to enroll with your company. When answering this question, try to focus on information that relates to the specific provider or insurer you’re working for.

Example: “Providers need to know what types of services they are covered for and what they aren’t. They should also know if there are any limitations to their coverage, such as whether certain procedures require pre-approval from the insurance company. Another important thing to remember is that providers must submit claims within 30 days of providing care. If they don’t, they could lose their eligibility for reimbursement.”

How would you help a provider who is having trouble submitting claims to their insurance company?

This question can help the interviewer assess your problem-solving skills and ability to provide customer service. Use examples from previous experience where you helped a provider submit claims or assisted them with understanding how to do so.

Example: “I would first ask the provider what their issue is, and then I would try to troubleshoot the problem with them. If it’s something that they can fix themselves, I will walk them through the process of submitting the claim. If there are issues with the insurance company, I will contact my supervisor for further instructions on how to proceed.”

What is your experience working with insurance companies and understanding their policies and procedures?

This question can help the interviewer determine your level of experience working with insurance companies and how you’ve applied that knowledge to your previous roles. Use examples from your past experience to highlight your ability to work with insurance companies, understand their policies and procedures and apply those skills to helping patients enroll in health care plans.

Example: “In my last role as a provider enrollment specialist, I worked directly with several insurance companies to ensure our patients were enrolled in the correct plan for their needs. This included understanding each company’s specific requirements for patient eligibility and ensuring they met all necessary qualifications before submitting applications. In addition, I also helped patients complete any required paperwork or forms needed to submit an application.”

Provide an example of a time when you helped a provider resolve a billing issue.

Interviewers ask this question to learn more about your customer service skills and how you resolve problems. Use examples from previous roles where you helped a provider with billing issues or other challenges they faced.

Example: “In my last role, I had a client who was having trouble submitting their claims electronically. They were using an older system that didn’t work well with our company’s electronic submission process. I spoke with the client to understand what kind of help they needed. We decided that it would be best for them to submit their claims by mail until we could upgrade their software. I worked with the IT department to create a workaround so the client could still submit their claims electronically.”

If a provider was unhappy with a decision made by their insurance company, how would you help them resolve the issue?

This question can help an interviewer understand how you would handle a challenging situation. Use your answer to highlight your problem-solving skills and ability to work with others.

Example: “If a provider was unhappy with a decision made by their insurance company, I would first listen to the issue they’re having. Then, I would contact the insurance company to find out more information about why they made that decision. If it’s appropriate, I may also speak with the provider directly to get additional details on what happened. After gathering all of this information, I would then try to resolve the issue as quickly as possible.”

What would you do if you noticed a provider was consistently billing for out-of-network services when an in-network option was available?

This question can help an interviewer assess your ability to make independent decisions and ensure that you’re upholding the company’s policies. In your answer, try to explain how you would handle this situation while also demonstrating your commitment to following procedures.

Example: “If I noticed a provider was billing for out-of-network services when in-network options were available, I would first speak with them about their billing practices. If they continued to bill for out-of-network services after our conversation, I would document my concerns and report them to my supervisor. My goal would be to uphold the organization’s policy of only offering in-network services while still maintaining positive relationships with providers.”

How well do you understand the different types of healthcare providers and the services they offer?

The interviewer may ask this question to assess your knowledge of the healthcare industry and how it works. Use your answer to highlight any experience you have working with providers, as well as your ability to learn about new types of providers if you don’t already know them.

Example: “I’ve worked in a hospital setting for five years now, so I’m very familiar with most common types of providers. However, I am always open to learning more about new services that providers offer. In my previous role, we hired a new provider who offered an innovative service that helped patients manage their chronic illnesses. I took some time to research the service and learned how it could help our patients.”

Do you have experience working with government healthcare providers?

This question can help the interviewer determine if you have experience working with a specific type of healthcare provider. If you do, they may ask you more about your experiences and how it helped you in this role. If you don’t, they may ask you to describe what you know about these providers.

Example: “I haven’t worked specifically with government healthcare providers, but I am familiar with them. In my last position as a provider enrollment specialist, I had to work with several different types of insurance companies, including Medicaid. This gave me valuable insight into how government-based insurance works and how we can best serve our patients.”

When working with a provider on their initial insurance enrollment, what are the most important things you need to collect from them?

This question is an opportunity to show your ability to work with providers and collect important information. When answering this question, it can be helpful to list the specific details you would need from a provider in order to complete their enrollment successfully.

Example: “When working with a new provider on their initial insurance enrollment, I find that it’s most helpful to have all of their contact information, including their address, phone number and email address. It’s also important to know what type of insurance they are currently enrolled in so we can make sure our company offers similar coverage at competitive rates. Finally, it’s essential to understand the types of patients they see regularly so we can ensure our network includes enough primary care physicians.”

We want to improve our provider satisfaction rates. Describe one strategy you would use to improve communication between providers and our customer service team.

This question is an opportunity to show your problem-solving skills and ability to work with a team. When answering this question, think about the ways you would improve communication between providers and customer service representatives.

Example: “I would start by having weekly meetings with my supervisor where we discussed any issues or concerns that providers have raised in their previous calls. This way, I can ensure our customer service representatives are aware of these issues so they can address them during future calls. In addition, I would make sure all customer service representatives were trained on how to communicate effectively with providers. This training could include tips for speaking clearly and using positive body language.”

Describe your experience working with electronic medical records and other digital tools used in healthcare.

Electronic medical records (EMRs) are a common tool used in healthcare. An interviewer may ask this question to learn more about your experience with EMRs and other digital tools, such as patient portals or telehealth applications. When answering this question, it can be helpful to mention any specific software you’ve worked with before.

Example: “I have extensive experience working with electronic medical records. In my last role, I was the primary person responsible for entering data into our EMR system. I also helped train new employees on how to use the system. I enjoy using technology to help streamline processes and make them more efficient.”

What makes you an ideal candidate to work with our healthcare providers?

This question is an opportunity to show the interviewer that you have a strong understanding of their company and its values. Use your answer to highlight any experience or skills that align with what they’re looking for in a provider enrollment specialist.

Example: “I am passionate about helping people, which is why I became a healthcare recruiter. Working with providers who are dedicated to improving the lives of others makes me excited to come into work every day. I also understand how important it is to find the right fit when recruiting new talent. My ability to listen carefully and communicate effectively helps me match candidates with positions that will be mutually beneficial.”

Which insurance companies have you worked with in the past and what was your experience like?

This question is a great way for the interviewer to get an idea of your experience with different insurance companies. It’s important that you have some experience working with multiple insurance providers, as this shows you’re adaptable and can work well with others. When answering this question, try to name at least two or three insurance companies you’ve worked with in the past.

Example: “In my previous role as a provider enrollment specialist, I worked with both Blue Cross and Blue Shield and Aetna. Both were challenging experiences, but I learned a lot from each one. With Blue Cross and Blue Shield, there was a lot of paperwork involved, which made it difficult to keep up with all of the information. However, with Aetna, I had more freedom to make decisions on my own.”

What do you think is the most challenging part of being a provider enrollment specialist?

This question can help an interviewer understand what you find challenging in your role and how you approach those challenges. When answering this question, it can be helpful to mention a specific challenge that you have overcome or are working on improving.

Example: “The most challenging part of my job is helping patients who don’t have insurance coverage for their healthcare needs. I enjoy helping people get the care they need, but sometimes there isn’t much I can do when someone doesn’t have insurance. However, I always try to refer them to other resources where they may be able to receive assistance.”

How often do you update your knowledge of insurance plans and provider requirements?

This question can help the interviewer determine how much you value your own education and development. Showcase your commitment to continuous learning by mentioning a few ways you stay up-to-date on industry news, regulations or changes in technology.

Example: “I am always looking for new resources that can help me learn more about insurance plans and provider requirements. I recently subscribed to an online newsletter that shares information about healthcare trends and updates. I also regularly attend webinars hosted by my company’s human resources department to learn about new benefits and policies.”

There is a discrepancy in a provider’s insurance information. How do you handle this?

This question is an opportunity to show your problem-solving skills and ability to work with providers. When answering this question, it can be helpful to provide a specific example of how you handled the situation in the past.

Example: “In my previous role as a provider enrollment specialist, I had a situation where a provider’s insurance information was incorrect. The provider claimed they were not enrolled in our network but we could not find them on any other networks either. After speaking with the provider, I found out that they had recently changed their address and did not update their information. I contacted the provider again and asked for their new address. Once I received the updated information, I was able to enroll them back into our network.”