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.
Insurance verification representative responsibilities
Here are examples of responsibilities from real insurance verification representative resumes:
- 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.
- Utilize knowledge of CPT, ICD-9, ICD-10 and HCPCS coding when verifying insurance.
- Review medical record information to identify all appropriate coding base on CMS HCC categories.
- Act as a liaison between members and providers; ensure CMS guidelines are being adhere to.
- Request and submit corrected claims by verifying CPT codes and ICD-9 codes for pend claims within time restraint guidelines.
- Retrieve authorization daily from Medicare & Medicaid insurance companies.
- Coordinate with insurance representatives, including Medicaid and Medicare.
- Maintain confidentiality of all information while adhering to all HIPAA guidelines/regulations.
- Provide financial counseling for patients and their families by explaining financial policies and providing available resources for alternative payment.
- Coordinate check-in processes by contacting insurance providers to verify correct insurance information and get authorization for proper billing codes.
Insurance verification representative skills and personality traits
We calculated that 21% of Insurance Verification Representatives are proficient in Patients, Insurance Verification, and Customer Service. They’re also known for soft skills such as Computer skills, Customer-service skills, and Interpersonal skills.
We break down the percentage of Insurance Verification Representatives that have these skills listed on their resume here:
- Patients, 21%
Verified Medicare, Medicaid, other government agencies and private insurance for new patients to determine their individualized eligibility and benefits.
- Insurance Verification, 14%
Collaborated with managers and Diabetes Therapy Associates to determine best practices for insurance verification.
- Customer Service, 11%
Answered phone calls from patients and customer services representatives with questions regarding insurance coverage.
- Medical Terminology, 6%
Worked in call center environment Skills Used Professionalism, courteous medical knowledge, medical terminology.
- Insurance Benefits, 4%
Verify insurance benefits and authorizations that are required both for inpatient and outpatient services.
- Insurance Eligibility, 4%
Verify insurance eligibility and obtain authorization for outpatient hospital visits (all specialties) and scheduled appointments.
Common skills that an insurance verification representative uses to do their job include "patients," "insurance verification," and "customer service." You can find details on the most important insurance verification representative responsibilities below.
Customer-service skills. Another soft skill that's essential for fulfilling insurance verification representative duties is customer-service skills. The role rewards competence in this skill because "representatives help companies retain customers by professionally answering questions and helping to resolve complaints." According to an insurance verification representative resume, here's how insurance verification representatives can utilize customer-service skills in their job responsibilities: "located customer records using various carrier billing systems and approved/denied insurance claims. "
Interpersonal skills. insurance verification representatives are also known for interpersonal skills, which are critical to their duties. You can see how this skill relates to insurance verification representative responsibilities, because "representatives should be able to create positive interactions with customers." An insurance verification representative resume example shows how interpersonal skills is used in the workplace: "register patients for all ancillary appointments.admission er representative excellent interpersonal relation skills. "
Listening skills. insurance verification representative responsibilities often require "listening skills." The duties that rely on this skill are shown by the fact that "representatives must listen carefully to ensure that they understand customers in order to assist them." This resume example shows what insurance verification representatives do with listening skills on a typical day: "communicated with patients regarding their financial responsibility and obtained either payment or set up payment plans. "
Patience. Another crucial skill for an insurance verification representative to carry out their responsibilities is "patience." A big part of what insurance verification representatives relies on this skill, since "representatives should be patient and polite, especially when interacting with dissatisfied customers." How this skill relates to insurance verification representative duties can be seen in an example from an insurance verification representative resume snippet: "answered any and all questions asked about the members medical policy skills used customer service, patience, and punctuality"
Problem-solving skills. Another skill commonly found on insurance verification representative job descriptions is "problem-solving skills." It can come up quite often in insurance verification representative duties, since "representatives must determine solutions to customers’ problems." Here's an example from a resume of how this skill fits into day-to-day insurance verification representative responsibilities: "maintained and documented claim status with medicaid, medicare and commercial insurance till final claim resolution is achieved. "
The three companies that hire the most insurance verification representatives are:
- SCA Health14 insurance verification representatives jobs
- Surgery.com11 insurance verification representatives jobs
- Community Health Systems7 insurance verification representatives jobs
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Compare different insurance verification representatives
Insurance verification representative vs. Patient care specialist
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.
There are some key differences in the responsibilities of each position. For example, insurance verification representative responsibilities require skills like "health insurance," "medical insurance," "benefits verification," and "insurance carriers." Meanwhile a typical patient care specialist has skills in areas such as "patient care," "cpr," "phone calls," and "emr." This difference in skills reveals the differences in what each career does.
Patient care specialists earn the highest salaries when working in the health care industry, with an average yearly salary of $32,483. On the other hand, insurance verification representatives are paid more in the health care industry with an average salary of $31,971.On average, patient care specialists reach similar levels of education than insurance verification representatives. Patient care specialists are 2.3% more likely to earn a Master's Degree and 0.8% more likely to graduate with a Doctoral Degree.Insurance verification representative vs. Medical billing clerk
A medical billing clerk is primarily in charge of processing payments and creating billing arrangements in clinics and hospitals. Among their responsibilities include gathering and verifying patient identification, handling insurance information, coding, updating databases, and maintaining records. It is also their responsibility to assist patients by filling out forms, answering their inquiries, and referring them to other services. Moreover, a medical billing clerk must monitor patient accounts and follow-up on delinquent patient accounts, coordinating with collection agencies as needed.
Each career also uses different skills, according to real insurance verification representative resumes. While insurance verification representative responsibilities can utilize skills like "insurance benefits," "health insurance," "outbound calls," and "benefits verification," medical billing clerks use skills like "medical billing," "healthcare," "insurance coverage," and "cpt-4."
Medical billing clerks earn a higher average salary than insurance verification representatives. But medical billing clerks earn the highest pay in the health care industry, with an average salary of $34,137. Additionally, insurance verification representatives earn the highest salaries in the health care with average pay of $31,971 annually.Average education levels between the two professions vary. Medical billing clerks tend to reach similar levels of education than insurance verification representatives. In fact, they're 0.4% less likely to graduate with a Master's Degree and 0.8% more likely to earn a Doctoral Degree.Insurance verification representative vs. Registration specialist
A registration specialist is responsible for managing patient information, including the verification of their insurance details and medical treatment schedules. Registration specialists assign admission rooms and processing payments for discharge. They also assist patients with the completion of medical forms by helping them fill-out papers with the most accurate information. A registration specialist performs administrative and clerical duties as needed, requiring them to have excellent data management skills to process information and provide the highest quality care services for the patients.
Some important key differences between the two careers include a few of the skills necessary to fulfill the responsibilities of each. Some examples from insurance verification representative resumes include skills like "benefits verification," "insurance carriers," "patient demographics," and "patient insurance coverage," whereas a registration specialist is more likely to list skills in "patient care," "phone calls," "insurance coverage," and "home health. "
Registration specialists earn the best pay in the health care industry, where they command an average salary of $30,648. Insurance verification representatives earn the highest pay from the health care industry, with an average salary of $31,971.Most registration specialists achieve a similar degree level compared to insurance verification representatives. For example, they're 0.6% more likely to graduate with a Master's Degree, and 0.4% more likely to earn a Doctoral Degree.Insurance verification representative vs. Authorization specialist
An authorization specialist is responsible for reviewing insurance claims and determining the necessary settlement for the clients and involved parties. Authorization specialists file documents and gather the required information for further investigation and analysis. They coordinate with the insurance agency and the medical institution and ensure that the correct communications are being sent out for reference. An authorization specialist must have excellent communication and organizational skills, especially in writing authorization requests and resolve claims timely and efficiently.
Types of insurance verification representative
Updated January 8, 2025
