Insurance verification representative vs patient care specialist

The differences between insurance verification representatives and patient care specialists 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 specialist. Additionally, a patient care specialist has an average salary of $34,157, 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 specialist are patients, patient care, and data entry.

Insurance verification representative vs patient care specialist overview

	Insurance Verification Representative	Patient Care Specialist
Yearly salary	$32,706	$34,157
Hourly rate	$15.72	$16.42
Growth rate	-4%	-4%
Number of jobs	150,260	146,861
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 28%	Bachelor's Degree, 40%
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 specialist do?

A patient service or care specialist works at different medical facilities. Primary responsibilities include checking patients in and out, scheduling follow-up appointments as well as checking patient eligibility for services or programs. Patient service specialists should maintain a systematic referral log to correlate patient referrals to other specialists. Applicants for the job should have the basic computer knowledge to effectively manage data of patient's files, knowledge of medical terminologies, and possess good interpersonal and customer service skills.

Insurance verification representative vs patient care specialist salary

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

	Insurance Verification Representative	Patient Care Specialist
Average salary	$32,706	$34,157
Salary range	Between $28,000 And $37,000	Between $20,000 And $55,000
Highest paying City	Charleston, WV	Boston, MA
Highest paying state	Massachusetts	Massachusetts
Best paying company	Student Conservation Association	KPG
Best paying industry	Health Care	Health Care

Differences between insurance verification representative and patient care specialist education

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

	Insurance Verification Representative	Patient Care Specialist
Most common degree	Bachelor's Degree, 28%	Bachelor's Degree, 40%
Most common major	Business	Business
Most common college	Stanford University	University of Pennsylvania

Insurance verification representative vs patient care specialist demographics

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

	Insurance Verification Representative	Patient Care Specialist
Average age	40	40
Gender ratio	Male, 15.1% Female, 84.9%	Male, 20.3% Female, 79.7%
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, 11.7% Unknown, 5.2% Hispanic or Latino, 21.1% Asian, 6.3% White, 55.0% American Indian and Alaska Native, 0.7%
LGBT Percentage	7%	7%

Differences between insurance verification representative and patient care 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.

Patient care specialist example responsibilities.

Use EMR software to manage patient records and files; reinforce and uphold patient confidentiality as required by HIPAA and clinic.
Utilize software applications to document call interactions using medical terminology and responsible for initially engaging patients by explaining the services.
Verify CPT codes along with diagnosis code for guarantee payment for surgeries.
Process daily fee tickets and correctly enter office visit ICD 9 and CPT codes into the system for billing.
Adhere to HIPPA confidentiality guidelines.
Track Medicaid eligibility of clients.

Insurance verification representative vs patient care 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 patient care specialist skills

Patients, 33%
Patient Care, 17%
Data Entry, 5%
Medical Terminology, 4%
CPT, 2%
CPR, 2%

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Insurance Verification Representative
Insurance Verification Representative vs Patient Care Specialist

Updated January 8, 2025

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