What Does a Verification Representative Do?
A verification representative is responsible for handling both incoming and outgoing calls to assist clients with their insurance verifications. Verification representatives solve insurance-related issues the customer may have and thus must be able to communicate and accurately discuss company policy and procedures. These representatives may encounter frustrated or upset customers, requiring the need to maintain a calm demeanor while resolving conflict.
This position will usually be located in an office or call center environment, with remote work becoming increasingly common. Although verification representatives are typically hired as employees of the company they support, this position may be subcontracted to a third party (outsourcing provider). An ideal employee for a verification representative position will have insurance-related certifications and stay up to date with the latest insurance policies and regulations.
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National Average Salary
Verification representative salaries vary by experience, industry, organization size, and geography. To explore salary ranges by local market, please visit our sister site zengig.com.
The average U.S. salary for a Verification Representative is:
Verification Representative Job Descriptions
When it comes to recruiting a verification representative, having the right job description can make a big difference. Here are some real world job descriptions you can use as templates for your next opening.
[Your Company Name] is searching for an outgoing and assertive verification representative. Are you outgoing and conversational? Do you enjoy talking to people and resolving their issues? If so, this position may be the one for you. The verification representative will be responsible for communicating and interacting with clients over the phone, both incoming and outgoing. The ideal candidate will be able to answer insurance-related questions, assist with insurance-related troubleshooting, and authorize any claims needed. They will be responsible for managing any relevant administrative duties as well. This may include processing charges and managing billing systems. If this position sounds like an ideal role for you, please don’t hesitate to apply. We would love to have you on our team!
Typical duties and responsibilities
- Listen and respond to patient inquiries and concerns regarding health plan benefits, account status, payment history, and medical services
- Maintain contact with health plan and medical group representatives
- Provide information about products and services
- Take orders, calculate charges, and process billing or payments
- Review or make changes to customer accounts
- Record details of customer contacts and actions taken
Education and experience
- High school diploma or its equivalent required
Required skills and qualifications
- Understanding of medical terminology, insurance collections, and billing
- Strong written and verbal communication
- Ability to think independently
- Excellent interpersonal skills
- Ability to recognize and manage priorities
- Bachelor’s degree
- 4+ years of experience authorizing claims and dealing with insurance
- Verify that sufficient information is available for accurate verification and eligibility. This step may require direct contact with the physician’s office and/or the patient
- Determine if a secondary insurance should be added to the patient account ensuring the appropriate payer is selected for Primary insurance
- Utilize the centers selected vendor for claims and eligibility and/or individual payer websites to obtain eligibility, benefits, and/or pre-certs and authorization information
- Enter the patient insurance information into patient accounting system ensuring the selection is the appropriate payer and associated financial class
- When the patient’s insurance is Out of Network notify the manager immediately. Follow the Policies and Procedures when accepting Out of Network payers
- ABC Company’s goal for each patient’s insurance verification is complete and accurate. The insurance verifier will document the findings in the patient account and will contact the patient with either estimated co-insurance, co-pay, and or deductible amounts due on or before the date of service as applicable
- The Insurance Verifier will call each patient as part of center compliance with CMS Conditions for Coverage guidelines in contacting patient’s prior to the date of service to review, Physician Ownership, Advance Directives and Patient Rights
- Obtain authorizations from insurance companies/physician offices. Ensure complete and accurate information is entered into the patient accounting system and the procedure scheduled, date of service, and facility name are on the authorization. Ensure the authorization has not expired
- Enter authorization into patient accounting system. Include the name/CPT codes effective date of the authorized procedures
- Ensure high cost implant/supply or equipment rental is included on authorization
- Check insurance company approved procedure lists/medical policies. If procedure is not payable, notify patient. If patient wants to proceed, obtain signature on Medicare ABN, or other non-covered notification form
- Calculate co-pay, and estimated co-insurance due from patients per the individual payer contract per the individual payer contract and plan as applicable
- Acceptance of in-network benefits for out-of-network payers must be pre-approved by ABC Company Compliance Dept
- Be familiar with individual payer guidelines and the process of collecting over the counter payments/deductibles/copay/co-insurance. Knowledge of payer contracts including Medicare, Medicaid, and other government contracts and guidelines and workmen’s compensation fee schedule
- Contact the patient and communicate the center financial policy
- Bachelor’s degree preferred but not required
- Experience checking authorizations
- Detailed and able to work in a high production environment
- Healthcare experience a must
- Local or within driving distance
- Must be experienced with CPT codes and ICD-10’s
- Must be fluent in Spanish
Our Insurance Verification teams are a committed, caring group of colleagues. We have a passion for creating positive patient interactions. If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise!
As an Insurance Verification Representative, you will be responsible for timely and accurate insurance verification as well as accurately interpreting managed care contracts.
- Conducts Insurance verification process within 24 hours of receipt of reservation/notification for both inpatient and outpatient services
- Follows scripted benefits verification format in appropriate systems custom benefits screen and record benefits
- Contacts physician to resolve issues regarding prior authorization or referral forms
- Perform electronic eligibility confirmation when applicable and document results
- Researches Patient Visit History to ensure compliance with the Medicare 72 hour rule
- Completes Medicare Secondary Payor Questionnaire as applicable for retention in Abstracting module
- Performs insurance verification and account status changes by assigned facility
- Communicates with hospital based Case Manager as necessary to ensure prompt resolution of pre-existing, non-covered, and re-certification issues
- Utilizes system account notes and Collections System account notes as appropriate to cut-n-paste benefit and pre-authorization information and to document key information
- Perform Insurance Verification activities based on production quotas. Fully capable of meeting quotas
- Equivalent work experience may substitute education
- Minimum of one year working in an insurance setting
- Verify that all demographic and insurance information is present in the chart
- Confirm the accuracy of both insurance and patient information that is in the billing system
- Use workflow to input information into the system
- Confirm that the time management and admit information is accurate in the billing system
- Identity any changes made to client information
- Identify any changes made by payors in each state
- Keep management informed of any problems viewing scanned charts
- Required to complete 70-80 tasks per day
- Other duties as assigned
- Good working knowledge of insurance terminology including the ability to read EOBs (Explanation of Benefits) is preferred
- Strong attention to detail
- Strong Data entry skills
- Good computer skills including the ability to be on multiple screens at once as well as use the zoom in and zoom out feature
- Organized with excellent follow through abilities
- Communicate effectively, both orally and in writing, in English
- Knowledge of HIPPA Requirements
Education and experience
- High School diploma or general education degree (GED) required
- One to three months related experience and/or training; or equivalent combination of education and experience preferred
Candidate Certifications to Look For
- Client Service Specialist Certification (CCSS) – The CCSS certification aims to provide an entry-level certification for a client service specialist or company representative. This certification will provide training and testing on proper conflict resolution procedures, customer service procedures, and other relevant topics. This is a great option for candidates in any representative position, especially verification representatives.
- Certified Customer Experience Professional (CCEP) – Becoming a certified customer experience professional can massively benefit candidates in the verification representative role, as it showcases a good understanding and professional level of skills in regard to customer service and experience.
- Certified Medical Office Manager (CMOM). The CMOM certification may be relevant to verification representatives due to their potential of dealing with administrative duties in the position. This certification provides pertinent information for medical office management and data entry roles.
Sample Interview Questions
- How would you handle and resolve an issue a client has with their insurance?
- How would you communicate the denial of an insurance claim?
- Describe a time you encountered an upset customer. How did you handle the situation?
- If a customer calls with a question related to unresolved billing or fees, how would you go about resolving this issue?
- Are you confident in your ability to communicate and resolve any potential interpersonal issues that may arise?
- What relevant certifications do you have that will help you with your job as a verification representative?
- If we choose you, are you confident you will be able to answer any questions you are presented with, or delegate these questions to the correct specialists?
- What are the most important skills for an insurance verification representative?