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What Does an Insurance Verifier Do?

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  • Written By: Mary McMahon
  • Edited By: Shereen Skola
  • Last Modified Date: 01 November 2016
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    2003-2016
    Conjecture Corporation
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An insurance verifier works with insurance claims at a medical practice to smooth the process and collect payments in a timely fashion. Familiarity with insurance billing and coding systems, along with electronic medical records and privacy practices, is usually necessary. The work environment is similar to that of other office jobs, although there is also a customer service aspect because insurance verifiers work directly with patients. This can require good communication skills and the ability to work with people from diverse backgrounds.

When patients enter a medical practice or hospital system, the insurance verifier collects information about their insurance policies. This information can help practitioners determine whether specific treatments and procedures are covered. Insurance verifiers can prepare bills for insurance companies, using their coding systems, and process claims as they move through the office. If the insurance refuses to pay a claim, the insurance verifier may appeal, or could work with the patient on filing an appeal if the office doesn’t handle this.

As patients change insurance policies, the insurance verifier may meet with them to discuss changes in coverage. This is also important for updates to patient files, to confirm that the most recent information is available. Errors in a file might result in problems like sending a bill to the wrong company, or using incorrect file numbers that result in a delay of payment. If patients lose insurance coverage, this can also be important information for the medical practice.

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In cases where pre-approval is needed for medical procedures, the insurance verifier may prepare and submit this paperwork. This can also include phone calls to insurance companies in situations where care providers and patients want immediate information about coverage. For example, a patient might want to wait on a test if it’s not covered, or a care provider might be able to recommend an alternative medication if a prescription is not part of the patient’s insurance plan. The insurance verifier needs to be able to communicate quickly and clearly to get up to date information.

This work can include back office billing and coding work as well as front office relations. Patients with questions about insurance coverage and billing practices may meet with the insurance verifier. In situations where claims are denied or care providers are not able to offer treatment because of concerns about the ability to pay, this may involve tense or unpleasant conversations. The ability to remain calm, professional, and friendly in such settings is critical for success in this job.

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