Job Role Description

Medical > Insurance Verifier

Salary National Average

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37640.0000 44630.0000 54370.0000

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Short Description:

An Insurance Verifier is responsible for confirming patient insurance coverage and benefits prior to medical appointments or procedures. They verify policy details, eligibility, and coverage limits while ensuring accurate billing and minimizing claim denials. The role involves coordinating with insurance providers, healthcare staff, and patients to clarify discrepancies or obtain pre-authorizations when necessary. Strong attention to detail, communication skills, and familiarity with insurance processes are essential for success in this position.

Duties / Responsibilities:

  • Confirm patient insurance coverage and eligibility for services before appointments or procedures.
  • Obtain prior authorizations or pre-certifications for specific medical treatments or procedures as required by insurers.
  • Contact insurance companies to verify policy details, coverage limits, and patient benefits.
  • Inform patients about their insurance coverage, including out-of-pocket costs, copayments, and deductibles.
  • Accurately document insurance information and verification details in the healthcare provider's system.
  • Investigate and resolve discrepancies in insurance coverage or claims processing.
  • Work closely with billing and coding departments to ensure accurate claims submissions.
  • Stay updated on changes in insurance policies, regulations, and requirements.
  • Address and resolve issues related to insurance claims denials or payment delays.
  • Ensure the accuracy of patient demographic and insurance information in records.

Skills / Requirements / Qualifications

  • Educational Background: High school diploma or equivalent; some roles may prefer an associate's degree in healthcare administration or a related field.
  • Experience: 1-2 years of experience in medical billing, insurance verification, or a related role.
  • Knowledge of Insurance Processes: Familiarity with insurance policies, medical terminology, and claims processing.
  • Technical Skills: Proficiency in healthcare software systems, electronic health records (EHR), and Microsoft Office Suite.
  • Communication Skills: Excellent verbal and written communication skills to interact with insurance companies and patients effectively.
  • Attention to Detail: Strong attention to detail for accurate documentation and data entry.
  • Problem-Solving Abilities: Capability to resolve insurance-related issues and discrepancies efficiently.
  • Regulatory Knowledge: Understanding of HIPAA regulations and compliance standards in healthcare.

Job Zones

  • Education: Most occupations in this zone require training in vocational schools, related on-the-job experience, or an associate's degree.
  • Related Experience: Previous work-related skill, knowledge, or experience is required for these occupations. 
  • Job Training: Employees in these occupations usually need one or two years of on-the-job experience and informal training with experienced workers. A recognized apprenticeship program may be associated with these occupations.
  • Job Zone Examples: These occupations usually involve communication and organizational skills to coordinate, supervise, manage, or train others to accomplish goals. Examples include food service managers, electricians, agricultural technicians, legal secretaries, interviewers, and insurance sales agents.
  • Specific Vocational Preparation in years: 1-2 years of preparation (6.0 to < 7.0)

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