Medical Insurance Verification Clerk Job Description, Key Duties and Responsibilities

This post provides detailed information on the medical insurance verification clerk job description, including the key duties, tasks, and responsibilities they commonly perform

It also highlights the major requirements you would be expected to fulfill to be hired for the medical insurance verification clerk role by most recruiters/employers.

What Does A Medical Insurance Verification Clerk Do?

Medical insurance verification clerks are charged with reviewing and confirming patient insurance information to ascertain eligibility, deductibles, co-pays, and covered services, as well as other policy details.

The primary duty in a medical insurance verification clerk job description is to reach out to insurance companies to access patient benefit information, referral requirements, policy coverage details, pre-certifications, and status, and to manage authorizations for upcoming services.

Other duties may include data entry of insurance data, addressing denied or rejected claims, investigating coding issues, updating patient records and making sure of overall billing compliance in line with insurance guidelines and regulations.

The verification work of a medical insurance verification clerk helps prevent claim denial and assists providers receive appropriate reimbursement.

According to PayrHealth, it is important to ensure accurate insurance verification in order to avoid not only revenue loss but also the loss of patients.

Insurance verification clerks report directly to claims processing managers or supervisors within a medical billing, patient access, or revenue cycle department in their establishment.

They are usually employed by hospitals, physician practices, outpatient clinics, dental offices, skilled nursing facilities, health insurance, billing companies and clearing houses.

If there’s any healthcare revenue cycle, then this job will exist.

Most employers typically want someone with a high school diploma and extensive on-the-job training in key areas, like coding, medical terminology, billing, compliance and insurance protocols.

Some prefer someone with Associate’s degree in medical billing/coding or health information technology or a similar field.

A certification, such as Certified Healthcare Access Associate (CHAA) from NAHAM demonstrates competence

The insurance verification clerk is a significant position in the face of increasing health costs, complex administration and regulations.

Proper verification curbs compliance risks and financial penalties across several global health models.

Top employers seek candidates with exceptional communication abilities useful in interpreting policy details.

They also require keen attention to detail and customer service skill-set that is handy in patient/provider interactions, and problem solving skills to resolve denials.

Competency in verification software/portals and ability to thrive in a fast paced and demanding environment are also important for success as a medical insurance verification clerk.

While there are no official licensure for insurance verification clerk specifically, these two organizations, National Association of Healthcare Access Management (NAHAM) and the American Health Information Management Association (AHIMA) help provide training, certifications and best practices guidelines as they are related to this field.

Medical Insurance Verification Clerk Job Description Sample/Example/ Template

The medical insurance verification clerk job description consists of the following duties, tasks, and responsibilities:

• Collect a complete and accurate demographic and insurance related information from patients when conducting registration
• Contact payers by phone, web or clearinghouses in order to verify insurance eligibility, policy status and coverage details
• Sort complex insurance policies and contracts to determine patient covered services and financial responsibility
• Communicate benefits breakdown, expected out-of-pocket costs and pre-certification requirements to patients
• Spot and address discrepancies between documented coverage details and payer information via thorough research.
• Document diligently all insurance verification activity, notes from payer correspondence and next step in clear details.
• Use current insurance data to update patient accounts and billing records into practice management system
• Work cooperatively with medical coders to ascertain proper coding alignment with verified coverage and payer guidelines
• Resolve denied claims by identifying root causes, fixing errors and resubmitting with appropriate documentation
• Keep an eye out for pended and delayed claims, persistently follow up until resolved, and provide payer feedback to billers
• Maintain a comprehensive procedures documentation for the purposes of reference and training
• Strictly follow HIPAA privacy and security regulations as you work with protected health information (PHI)
• Take part in continuous training to stay updated with changing policies and rules
• Build a personable relationship with payer representatives to streamline verification processes
• Escalate highly complex cases that require policy exceptions/override to management for approval
• Cross-grain staff members on appropriate verification protocols and act as a subject matter resource
• Spot recurring issues, denial patterns, and process errors and then recommend improvement ideas
• Show excellent time management skills, alongside the ability to multitask effectively among competing demands
• Demonstrate leadership orientation and exemplary customer service skill-set when interacting with patients, clinical staff and third-party payers
• Dedicated to continuous process improvement by optimizing processes and minimizing revisions
• Use routine quality assurance reviews to audit completed verifications and claims for accuracy
• Be open to workflow automation and novel insurance verification technologies
• Snapshot and report on key performance metrics like denials overturned, verifications per hour, etc.
• Work cooperatively with patient access, billing and coding teams to ensure smooth revenue cycle management.

Medical Insurance Verification Clerk Job Description for Resume

If you have worked before or are currently working in the role of a medical insurance verification clerk and are making a new resume or CV, then you can craft a compelling Professional Experience section for your resume by applying the sample insurance verification clerk job description provided above.

You can highlight the important duties and responsibilities you have carried out or are presently performing as an insurance verification clerk by utilizing the ones contained in the above job description example.

By this, your resume will be more convincing to the recruiter/employer that you have been successful performing the functions of an insurance verification clerk in a medical facility, which can greatly enhance your chances of being hired for the new position that you are seeking, especially if it requires someone with some insurance verification clerk work experience.

Medical Insurance Verification Clerk Requirements: Skills, Knowledge, and Abilities for Career Success

To be successful in your career as an insurance verification clerk in a medical establishment, and to enhance your chances of being hired on your next job application, the following are important requirements you may be expected to meet:

• Versed in medical insurance terminology, products, plans and associated billing requirements
• Proven competence to adapt to evolving payer requirements and protocols
• Have team spirit orientation and ability to build relationship across departments
• Organized and can manage multiple priorities in a fast-paced environment
• Adept at working with practice management software, verification portals, and electronic data interchange (EDI)
• Exceptional attention to details and solid analytical skills to interpret nuanced insurance language
• Remarkable verbal and written abilities to pass complex ideas in a clear manner
• Skilled at identifying coding issues, addressing discrepancies and overturning denied claims
• Possess a patient and empathetic customer service mentality useful in explaining policies to patients in an apt manner
• Deep familiarity with regulatory standards, like HIPAA
• Willingness to work with new technologies and process improvement initiatives
• Possess problem solving prowess and resourcefulness in cases that need escalation.

Medical Insurance Verification Clerk Employment

The number of medical insurance verification clerks, also called insurance claims and policy processing clerks in employment in the United States is 241,650 in 2023, according to the U.S. Bureau of Labor Statistics.

Industries with the highest employments for these clerks include Agencies, Brokerages, and Other Insurance Related Activities and Insurance Carriers with employments of 100,400 and 88,460 respectively.

Medical Insurance Verification Clerk Salary

According to Zippia, the current average salary for an insurance verification specialist or clerk in the United States is $33,043 per year, with a total pay range of $28,000 and $37,000 annually

The top paying States in the U.S. for insurance verification specialists or clerks include South Dakota, $40,900 yearly and Alaska, $42,398 annually.

Conclusion

This is an in-depth guide that offers a detailed understanding of the medical insurance verification clerk job description.

Insurance verification clerk play a key role in healthcare revenue cycle management.

From key responsibilities to industry skills, to employers’ requirements, and to top paying locations, candidates seeking to enter this career will gain remarkable insights from this post.

Employers can also benefit by using this resource to create a well-detailed job description template that can attract applications from talented medical insurance verification clerks.

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