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How much do medical verification specialist jobs pay per hour?

As of Aug 22, 2026, the average hourly pay for medical verification specialist in the United States is $18.87, according to ZipRecruiter salary data. Most workers in this role earn between $16.35 and $20.19 per hour, depending on experience, location, and employer.

What is a medical verification specialist?

Medical Verification Specialists are professionals responsible for verifying patient information, insurance coverage, and medical benefits before services are rendered. They ensure that all patient data is accurate and that insurance policies are active and cover the required procedures. Their work helps prevent claim denials, reduces billing errors, and ensures a smooth billing process for both healthcare providers and patients. They often communicate with insurance companies, review documentation, and update records to streamline the administrative side of healthcare.

What are some common challenges faced by medical verification specialists when verifying patient insurance information?

Medical Verification Specialists often encounter challenges such as obtaining timely and accurate responses from insurance companies, dealing with complex or ambiguous coverage policies, and navigating frequent changes in insurance plans. Additionally, they may need to clarify details with both patients and providers to ensure all necessary information is accurate for billing purposes. Effective communication skills, persistence, and attention to detail are crucial to overcome these obstacles and help prevent claim denials or delays.

What are the key skills and qualifications needed to thrive as a medical verification specialist, and why are they important?

To thrive as a Medical Verification Specialist, you need strong attention to detail, knowledge of medical terminology, and experience with insurance processes, often supported by a high school diploma or relevant healthcare certification. Familiarity with electronic health record (EHR) systems, insurance databases, and verification software is commonly required. Excellent communication, organizational abilities, and problem-solving skills distinguish top performers in this role. These competencies are crucial for ensuring accurate patient information, minimizing billing errors, and facilitating smooth healthcare operations.

What is the difference between Medical Verification Specialist vs Medical Records Coordinator?

AspectMedical Verification SpecialistMedical Records Coordinator
CredentialsOften requires medical or healthcare-related certifications, familiarity with verification processesTypically requires health information management or medical records certifications
Work EnvironmentHealthcare offices, insurance companies, or medical facilitiesHospitals, clinics, or healthcare organizations
Employer & Industry UsageUsed in insurance, healthcare, and staffing agencies for verifying provider credentialsUsed in healthcare facilities for managing patient records and documentation
Search & Comparison IntentPeople compare roles related to verifying healthcare credentials and insurance infoPeople compare roles related to managing and organizing medical records

The Medical Verification Specialist focuses on confirming healthcare provider credentials and insurance information, often working in insurance or healthcare settings. In contrast, the Medical Records Coordinator manages and maintains patient records within healthcare facilities. While both roles require healthcare knowledge and documentation skills, their primary responsibilities and work environments differ.

More about Medical Verification Specialist jobs

What job categories do people searching Medical Verification Specialist jobs look for?

The top searched job categories for Medical Verification Specialist jobs are:

Medical Verification Specialist jobs near you
Infographic showing various Medical Verification Specialist job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 15% Part Time, and 7% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $39,247 per year, or $18.9 per hour.

Medical Benefits Verification Specialist

Onco360

Houston, TX

$23/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 19 days ago

Onco360 rating

7.7

Company rating: 7.7 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

20th of 113 rated pharmacies

Job description

Are you someone looking for professional career growth? Onco360 Pharmacy is looking for a Medical Benefits Verification Specialist for our Pharmacy located in Houston, TX.
Work Hours: Monday-Friday 8:30-5 EST, may adjust according to Time Zone of candidate.
**Starting salary at $23/hour** We also offer quarterly incentive bonuses.
We offer a variety of benefits including:
  • Medical, Dental amp; Vision insurance
  • 401k with a match
  • Paid Time Off and Paid Holidays
  • Tuition Reimbursement
  • Paid Volunteer Day
  • Floating Holiday
  • Referral Incentive
  • Paid Life, and short amp; long-term disability insurance
Medical Benefits Verification Specialist Summary:
The Medical Benefit Verification Specialist will investigate, review, and load accurate patient insurance for medical coverage, assign coordination of benefits, and investigate/identify authorization requirements needed to obtain medication coverage. They will ensure accurate insurance benefit documentation is made for specific IV and oral therapy orders.
Medical Benefits Verification Specialist Major Responsibilities:
  • Verify Government payer (i.e. Medicare and Medicaid) eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile. This involves contacting Medicare or other relevant government payers to confirm coverage and benefits for specific services.
  • Verify Commercial insurance plans eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile. Confirming patient eligibility and benefits with various commercial insurance carriers (i.e. Aetna, Humana, Anthem, Cigna, etc.).
  • Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information and patient copays, deductibles and Out-of-Network responsibilities.
  • Determine optimal reimbursement based on medical plan and dispensing location, then document outcome of benefits review in CPR+ system to be used by operations and ensure the order is assigned to the appropriate dispensing pharmacy.
  • Facilitate process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claims.
  • Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information, doctors’ notes, assessments and lab reports.
  • Communicate succinctly and professionally both verbally and through written correspondence with Physician offices, nurses, insurance companies and patients as needed.
  • Exhibits a positive, courteous, respectful, and helpful attitude towards patients, team members, payers, and management. Contributes team effort by accomplishing related tasks as needed and other duties as assigned.
  • Research proper billing policies and procedures for all payer types, ensuring claims are processed correctly against industry and government standards and regulations, adhere to company compliance, integrity, patient privacy, and ethical billing practices.
  • Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
Education/Learning Experience
  • Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification
  • Desired: Associate degree or equivalent program from a 2-year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience
Work Experience
  • Required: 1+ years’ Medicare and Medical benefit verification experience
  • Desired: 3+ years Specialty Pharmacy, Medical Verification, and/or Infusion benefit verification experience
Skills/Knowledge
  • Required: Medicare and Medical insurance and benefit verification, medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, coordination of benefits, Understanding Medicare Parts A, B, C, and D, as well as relevant laws and guidelines, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, basic math and analytical skills, Intermediate typing/keyboarding skills.
  • Desired: Specialty Pharmacy experience, Medicare Billing Experience, Medical Authorization experience
Licenses/Certifications
  • Required: None
  • Desired: Registration with Board of Pharmacy as required by state law or Certified Pharmacy Technician (PTCB)
Behavior Competencies
  • Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills
Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.
A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion.
We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.

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