Insurance verification representative vs insurance verification specialist

The differences between insurance verification representatives and insurance verification specialists can be seen in a few details. Each job has different responsibilities and duties. Additionally, an insurance verification specialist has an average salary of $33,043, which is higher than the $32,706 average annual salary of an insurance verification representative.

The top three skills for an insurance verification representative include patients, insurance verification and customer service. The most important skills for an insurance verification specialist are patients, insurance verification, and customer service.

Insurance verification representative vs insurance verification specialist overview

	Insurance Verification Representative	Insurance Verification Specialist
Yearly salary	$32,706	$33,043
Hourly rate	$15.72	$15.89
Growth rate	-4%	6%
Number of jobs	150,260	71,688
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 28%	Associate Degree, 27%
Average age	40	46
Years of experience	4	-

What does an insurance verification representative do?

An insurance verification representative is responsible for ensuring the coverage of a patient's healthcare benefits by required procedures. Your duties will typically include updating patient information, verifying insurance coverage of patients, and arranging payment for medical services that are not covered under insurance. In addition, you will be checking eligibility and benefits for healthcare providers and explaining Medicare and CMS guidelines as needed. As an insurance verification representative, you are also expected to advise and discuss various financing options that best fit a patient's budget.

What does an insurance verification specialist do?

An insurance verification specialist is responsible for confirming a patient's insurance details and eligibility to receive medical care services. Insurance verification specialists review the insurance documents of the patients, including its coverage and limitations, and escalate concerns to the supervisor for immediate resolution. They process paperwork accordingly upon coordinating with the patients and attending health professionals. An insurance verification specialist must have excellent communication and organizational skills, finishing administrative tasks efficiently under minimal supervision.

Insurance verification representative vs insurance verification specialist salary

Insurance verification representatives and insurance verification specialists have different pay scales, as shown below.

	Insurance Verification Representative	Insurance Verification Specialist
Average salary	$32,706	$33,043
Salary range	Between $28,000 And $37,000	Between $28,000 And $37,000
Highest paying City	Charleston, WV	Madison, WI
Highest paying state	Massachusetts	New Hampshire
Best paying company	Student Conservation Association	St. Luke's Cataract & Laser Institute
Best paying industry	Health Care	Pharmaceutical

Differences between insurance verification representative and insurance verification specialist education

There are a few differences between an insurance verification representative and an insurance verification specialist in terms of educational background:

	Insurance Verification Representative	Insurance Verification Specialist
Most common degree	Bachelor's Degree, 28%	Associate Degree, 27%
Most common major	Business	Health Care Administration
Most common college	Stanford University	University of Pennsylvania

Insurance verification representative vs insurance verification specialist demographics

Here are the differences between insurance verification representatives' and insurance verification specialists' demographics:

	Insurance Verification Representative	Insurance Verification Specialist
Average age	40	46
Gender ratio	Male, 15.1% Female, 84.9%	Male, 11.4% Female, 88.6%
Race ratio	Black or African American, 12.6% Unknown, 4.8% Hispanic or Latino, 22.0% Asian, 6.3% White, 53.8% American Indian and Alaska Native, 0.6%	Black or African American, 9.3% Unknown, 3.6% Hispanic or Latino, 16.0% Asian, 4.9% White, 66.1% American Indian and Alaska Native, 0.1%
LGBT Percentage	7%	7%

Differences between insurance verification representative and insurance verification specialist duties and responsibilities

Insurance verification representative example responsibilities.

Coach, evaluate and performance manage MSRs to ensure timely and accurate service to clients.
Practice confidentiality while handling patients' medical information with use of the HIPAA law.
Verify Medicare, Medicaid, other government agencies and private insurance for new patients to determine their individualize eligibility and benefits.
Verify HMO referrals and treatment plans are authorize.
Have knowledge in difference between HMO and PPO insurance.
Comply with HIPPA due to the nature of client information.

Insurance verification specialist example responsibilities.

Check CPT and ICD-10 codes with LCD and policies from multiple insurance companies to make sure procedures will be paid.
Support the patient privacy/confidentiality policies and regulations under HIPAA for patients and their medical records.
Confirm correct charges base on HCPCS codes.
Assist callers as well with questions about their benefits, terms and conditions of medical plans, appeals and grievances.
Provide medical record support in the absence of EMR: assist clinics and hospitals in obtaining medical records in appropriate format.
Document outbound communication from providers and veterans.

Insurance verification representative vs insurance verification specialist skills

Common insurance verification representative skills

Patients, 21%
Insurance Verification, 14%
Customer Service, 11%
Medical Terminology, 6%
Insurance Benefits, 4%
Insurance Eligibility, 4%

Common insurance verification specialist skills

Patients, 25%
Insurance Verification, 15%
Customer Service, 7%
Insurance Eligibility, 5%
Data Entry, 4%
Medical Terminology, 4%

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Insurance Verification Representative
Insurance Verification Representative vs Insurance Verification Specialist

Updated January 8, 2025

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