Insurance verification representative vs patient care representative

The differences between insurance verification representatives and patient care representatives can be seen in a few details. Each job has different responsibilities and duties. It typically takes 2-4 years to become both an insurance verification representative and a patient care representative. Additionally, a patient care representative has an average salary of $33,709, 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 a patient care representative are patients, patient care, and home health.

Insurance verification representative vs patient care representative overview

	Insurance Verification Representative	Patient Care Representative
Yearly salary	$32,706	$33,709
Hourly rate	$15.72	$16.21
Growth rate	-4%	-4%
Number of jobs	150,260	133,317
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 28%	Bachelor's Degree, 39%
Average age	40	40
Years of experience	4	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 a patient care representative do?

PCRs (Patient Care Representatives) are given responsibilities like updating and verifying patient information after every visit, scheduling and reminding patients about appointments, and informing patients about delays and how long the estimated waiting times will be. They are also responsible for obtaining patients' personal information like their address, contact details, insurance information, and medical and surgical history. They must be able to communicate with patients, family members, and medical staff to give them all the information they need to treat the person looking for medical help.

Insurance verification representative vs patient care representative salary

Insurance verification representatives and patient care representatives have different pay scales, as shown below.

	Insurance Verification Representative	Patient Care Representative
Average salary	$32,706	$33,709
Salary range	Between $28,000 And $37,000	Between $27,000 And $41,000
Highest paying City	Charleston, WV	Boston, MA
Highest paying state	Massachusetts	Alaska
Best paying company	Student Conservation Association	Massachusetts General Hospital
Best paying industry	Health Care	Technology

Differences between insurance verification representative and patient care representative education

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

	Insurance Verification Representative	Patient Care Representative
Most common degree	Bachelor's Degree, 28%	Bachelor's Degree, 39%
Most common major	Business	Business
Most common college	Stanford University	University of Pennsylvania

Insurance verification representative vs patient care representative demographics

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

	Insurance Verification Representative	Patient Care Representative
Average age	40	40
Gender ratio	Male, 15.1% Female, 84.9%	Male, 17.1% Female, 82.9%
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, 12.5% Unknown, 5.1% Hispanic or Latino, 20.3% Asian, 6.3% White, 55.2% American Indian and Alaska Native, 0.6%
LGBT Percentage	7%	7%

Differences between insurance verification representative and patient care representative 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.

Patient care representative example responsibilities.

Manage cash and co-payments accurately and discharge patients providing them with proper medical notes and information before exiting.
Verify insurance, Medicaid, Medicare, register patients, and code proper ICD-9 and CPT codes on encounters.
Utilize medical terminology, CPT, HCPC and ICD-9 and patient information into new authorizations.
Interview patients to gather information pertinent to their Medicaid application.
Screen, identify, and enter ICD-9 coding from treatment record forms.
Maintain patient confidentiality and follow HIPAA rules.

Insurance verification representative vs patient care representative skills

Common insurance verification representative skills

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

Common patient care representative skills

Patients, 25%
Patient Care, 13%
Home Health, 7%
Cash Management, 5%
Phone Calls, 4%
CPT, 3%

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Insurance Verification Representative
Insurance Verification Representative vs Patient Care Representative

Updated January 8, 2025

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