Business analyst interview questions and answers

Basic Questions to Cover Healthcare Understanding

1. What is Healthcare?
2. What is Insurance? How does it differ with Healthcare?
3. Do I need Healthcare Insurance to get treated by a Doctor?
4. If I have insurance, who pays the doctor for performing services on me, the member?
5. Define Business Requirements? Does a Business Analyst need to know all about a specific Business Area?
6. What is difference between group and individual insurance? If you are working with Walmart, and you have insurance, which form is it?
7. What is a Premium? Who pays the Premium to whom and why?
8. Why is there an IT department in a Healthcare Company?
9. What is the difference between by PPO and POS? Why is HMO so easily affordable? How come the premiums are low?
10. What is a Provider? What are the two types of Providers? What Provider Networks do Healthcare Companies Leverage?
11. What is an Underwriter? What is the role of an Underwriter if a healthcare insurance company just got a contract with 1000 employees of BEST BUY?
12. Define HIPAA? What does HIPAA regulate and prevent?
13. Please provide a one liner introduction for the following Business Areas – Enrollment, Claims, Benefits Admin, Provider Systems Admin, Finance, Billing, and Dictionary Maintenance?
14. Compute Member Payment and Healthcare Insurance Payment for:

Deductible: $1000
Co-Pay: $25
Co-Insurance: 20%

1^st Visit: Doctors Bill: $800
2^nd Visit: Doctors Bill: $600

1. What is a Claim? What different entities can submit a Claim? What are the two types of Claim Intake Processes?
2. Please provide one liner about professional, facility, medicare and Medicaid claims?
3. Please provide basic understanding of a Claim Flow? What happens in a company like BCBS when a Claim arrives through EDI?
4. What is adjudication? What is Auto Adjudication? What is a High dollar Claim?
5. What are the two types of forms used by providers for paper based claims?
6. What is the job of a Clearing house? Who mandates EDI rules to be followed?
7. Briefly describe EDI 837, 835, 276 and 277
8. What is COB? What is primary and secondary insurer?
9. What is the ICD 9 – 10 Conversion? What is the basic understanding of these changes? Research about GEM – General Equivalence Mapping.
10. What is Medicare Fraud? Give an example of how a provider can commit fraud.
11. Research about HIPAA 5010 regulations. What does it specify Healthcare Companies do?

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