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What Is an Insurance Verification Specialist and How to Become One

What Is an Insurance Verification Specialist and How to Become One Image

What Does an Insurance Verification Specialist Do?

An insurance verification specialist double checks the status of patients’ medical insurance. Their primary responsibility is to ensure that a patient’s insurance will cover required medical procedures or hospital stays. Other duties include verifying patient information, billing, medical coding, and conducting claims examinations. Specialists may also be expected to educate the patient about their coverage.

How to Become an Insurance Verification Specialist

Some insurance verification specialist jobs require an associate’s degree in medical administration or a related health field, while others may only need a high school diploma and on the job training. In these education programs, you study the basics of patient privacy law, medical billing, and hospital administrative duties to gain the skills you need to be successful in this career. You may also choose to get a voluntary certification, such as the Health Insurance Portability and Accountability Act (HIPAA) Certification.

Insurance Verification Specialist Job Description Sample

With this Insurance Verification Specialist job description sample, you can get a good idea of what employers are looking for when hiring for this position. Remember, every employer is different and each will have unique qualifications when they hire for a Insurance Verification Specialist role.

Job Summary

Our healthcare facility is currently seeking an Insurance Verification Specialist. In this role, you will verify insurance coverage for new patients and referrals, as well as update information for existing patients. Your duties will also involve calling to obtain pre-authorization for services, which requires strong phone communication skills. After verifying coverage, you will help patients understand what their financial responsibilities will be. Applicants should have an associate degree and medical billing experience. Bilingual communication skills are a major plus.

Duties and Responsibilities

  • Verify insurance information for new patients and referrals
  • Update insurance information for existing patients
  • Call to obtain pre-authorization for recommended services and procedures
  • Explain to patients what their financial responsibilities will be
  • Inform relevant clinical staff about denials
  • Answer questions related to billing and insurance

Requirements and Qualifications

  • High school diploma or GED certificate
  • Associate degree (or equivalent experience)
  • Medical billing experience (2 years preferred)
  • Knowledge of CPT codes and basic medical terminology (preferred)
  • Phone communication skills
  • Bilingual ability (English/Spanish) a plus