Insurance verification representative vs provider services representative

The differences between insurance verification representatives and provider services representatives can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 2-4 years to become an insurance verification representative, becoming a provider services representative takes usually requires 6-12 months. Additionally, a provider services representative has an average salary of $33,858, 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 provider services representative are customer service, data entry, and patients.

Insurance verification representative vs provider services representative overview

	Insurance Verification Representative	Provider Services Representative
Yearly salary	$32,706	$33,858
Hourly rate	$15.72	$16.28
Growth rate	-4%	-4%
Number of jobs	150,260	252,118
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 28%	Bachelor's Degree, 41%
Average age	40	40
Years of experience	4	12

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 provider services representative do?

A provider services representative is responsible for supporting, developing, and maintaining service relationships with involved participants, including providers, physicians, and administrators. Your duties typically include responding to direct and electronic questions from clients about rates, policies, referrals, and eligibility, handling telephone calls for the provider and member inquiries, and resolving complaints by the member and member representative. In addition, you will be assisting in collecting supporting data and documentation about the member's care. You are also expected to conduct research to be able to provide a well-informed answer to members' inquiries.

Insurance verification representative vs provider services representative salary

Insurance verification representatives and provider services representatives have different pay scales, as shown below.

	Insurance Verification Representative	Provider Services Representative
Average salary	$32,706	$33,858
Salary range	Between $28,000 And $37,000	Between $24,000 And $46,000
Highest paying City	Charleston, WV	New York, NY
Highest paying state	Massachusetts	New York
Best paying company	Student Conservation Association	Oracle
Best paying industry	Health Care	Health Care

Differences between insurance verification representative and provider services representative education

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

	Insurance Verification Representative	Provider Services Representative
Most common degree	Bachelor's Degree, 28%	Bachelor's Degree, 41%
Most common major	Business	Business
Most common college	Stanford University	-

Insurance verification representative vs provider services representative demographics

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

	Insurance Verification Representative	Provider Services Representative
Average age	40	40
Gender ratio	Male, 15.1% Female, 84.9%	Male, 22.2% Female, 77.8%
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, 11.5% Unknown, 5.1% Hispanic or Latino, 20.4% Asian, 6.4% White, 55.9% American Indian and Alaska Native, 0.7%
LGBT Percentage	7%	7%

Differences between insurance verification representative and provider services 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.

Provider services representative example responsibilities.

Coach, evaluate and performance manage MSRs to ensure timely and accurate service to clients.
Achieve excellent customer satisfaction ratings as documented by CIGNA surveys.
Proof reading contracts in order to adjust claims according to proper DRG, ICD-9, and CPT codes.
Complete the surgery schedule and ensure all patients are aware of their financial responsibility prior to the surgery date.
Help providers with all information about CPT codes such as authorizations, restrictions, fee schedules, and correct diagnosis codes.
Register patients for surgery in computer system.

Insurance verification representative vs provider services 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 provider services representative skills

Customer Service, 24%
Data Entry, 6%
Patients, 5%
Medicaid, 5%
Health Insurance, 4%
Appeals, 3%

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Insurance Verification Representative
Insurance Verification Representative vs Provider Services Representative

Updated January 8, 2025

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