An insurance verifier typically works with electronic medical records, as well as billing and coding systems.
An insurance verifier works with insurance claims in a doctor’s office to facilitate the process and receive payments in a timely manner. Familiarity with insurance billing and coding systems is often required, along with electronic medical records and privacy practices. The work environment is similar to other office jobs, although there is also a customer service aspect as insurance verifiers work directly with patients. This may require good communication skills and the ability to work with people from diverse backgrounds.
When patients enter a doctor’s office or hospital system, the insurance verifier collects information about their insurance policies.
When patients enter a doctor’s office or hospital system, the insurance verifier collects information about their insurance policies. This information can help doctors determine if specific treatments and procedures are covered. Insurance inspectors can prepare invoices for insurers using their coding systems and process claims as they move through the office. If insurance refuses to pay a claim, the insurance examiner can appeal or work with the patient to file an appeal if the office does not take over.
As patients change insurance policies, the insurance verifier may meet with them to discuss changes in coverage. This is also important for patient file updates, to confirm that the latest information is available. Errors in a file can lead to problems, such as sending an account to the wrong company or using the wrong file numbers, resulting in a late payment. If patients lose insurance coverage, this can also be important information for the medical practice.
In cases where prior approval is required for medical procedures, the insurance verifier can prepare and submit this documentation. This may also include calling insurers in situations where healthcare professionals and patients want immediate coverage information. For example, a patient may want to wait for a test if it is not covered, or a care provider may recommend an alternative medication if the prescription is not part of the patient’s insurance plan. The insurance examiner must be able to communicate quickly and clearly to get up-to-date information.
This work may include back office billing and coding work, as well as front office relationships. Patients with questions about insurance coverage and billing practices can meet with the insurance verifier. In situations where claims are denied or care providers are unable to provide treatment due to concerns about ability to pay, this can lead to tense or unpleasant conversations. The ability to remain calm, professional and friendly in such environments is critical to success in this job.