An insurance verifier assists a medical practice with insurance claims in order to expedite the process and collect payments on time. It is usually necessary to be familiar with insurance billing and coding systems, as well as electronic medical records and privacy practices. Because insurance verifiers work directly with patients, the work environment is similar to that of other office jobs. There is also a customer service aspect to the job. This may necessitate strong communication skills as well as the ability to collaborate with people from various backgrounds.
The insurance verifier collects information about patients’ insurance policies when they enter a medical practice or hospital system. This data can assist practitioners in determining whether or not certain treatments and procedures are covered. Insurance verifiers can use their coding systems to prepare bills for insurance companies and process claims as they pass through the office. If an insurance company refuses to pay a claim, the insurance verifier may file an appeal on behalf of the patient, if the office does not handle this.
The insurance verifier may meet with patients as their insurance policies change to discuss coverage changes. This is also necessary for updating patient files and ensuring that the most up-to-date information is available. Errors in a file can cause issues such as sending a bill to the wrong company or using incorrect file numbers, causing payment delays. If a patient’s insurance coverage is terminated, this can be crucial information for the medical practice.
When pre-approval for medical procedures is required, the insurance verifier may prepare and submit the necessary paperwork. This can also include calling insurance companies in situations where care providers and patients require immediate coverage information. For example, if a test isn’t covered, a patient might want to postpone it, or if a prescription isn’t covered, a care provider might be able to suggest an alternative medication. To obtain current information, the insurance verifier must be able to communicate quickly and clearly.
Back office billing and coding, as well as front office relations, are examples of this work. The insurance verifier can meet with patients who have questions about their insurance coverage or billing practices. When claims are denied or care providers are unable to provide treatment due to concerns about the ability to pay, tense or unpleasant conversations may ensue. It is critical for success in this job to be able to remain calm, professional, and friendly in such situations.