Medical Insurance Verification Clerk Job Description

By | May 12, 2015
Medical Insurance Verification Clerk job description, duties, tasks, responsibilities

Medical Insurance Verification Clerks perform various functions, including verifying and entering patients’ insurance coverage information. Image source:

Medical Insurance Verification Clerk Job Description Sample, Including Duties, and Responsibilities

What Does a Medical Insurance Verification Clerk Do?

The medical insurance verification clerk plays the role of verifying and entering patients’ insurance coverage information, including benefits, at a retail pharmacy store, hospital or clinic, or at a doctor’s office.

The job description of medical insurance verification clerks has become a bit more complex over the years with the medical insurance industry becoming complex.

These professionals are responsible for validating patients’ billing information, selecting and completing the insurance coverage information for the patient in their quest to access medical care.

Their duties include calling up private insurance companies where patients have accounts, Medicare, and Medicaid, to verify and obtain information concerning insurance benefits accruing to them.

They determine if patients’ insurance is compatible with their company’s health-care programs or not, and if it does, they work with the patient in getting maximum benefits from the program.

The insurance verification clerk also updates and re-files patients’ claims, re-verify patient’s current insurance, and find out if a patient’s insurance benefit plan takes into consideration all selected products needed by the patient.

Working in a hospital or clinic, he/she verifies insurance for both pre-admission and patients on admission; for patients for day surgeries and for specified procedures, and immediately informs the Finance Department or Business Office about patients who are underinsured or without insurance.

To pursue a career in this field requires a clean criminal record without a history of drug abuse, a minimum of a high school diploma, and one to three years working experience as an insurance verification personnel, or working on a medical insurance program, or in a medical billing setting.

Sample Job Description for the Medical Insurance Verification Clerk Position

Here is a sample of the medical insurance verification clerk’s job description, showing vital tasks, duties, and responsibilities that make up the daily work schedule of the individual holding the post.

  • Responsible for reviewing patients’ case and insurance coverage information to personalize the call contents to the patient.
  • Choose the right HARP internal software insurance code following information provided on patients’ insurance.
  • Study patients’ scanned requisition record and input all information relating to insurance coverage.
  • Take and verify all patients’ demographic information when registering them for the service or program.
  • Identify important patient and demographic information that are missing and inform client about them to avoid claim processing issues with the insurer.
  • Establish contact with the ordering physician’s office or customer service department to resolve issues concerning missing vital information from patients scanned requisition record.
  • Ensure timely processing of benefit information and seek assistance from management when necessary.
  • Work cordially in a team and participate in meetings, sharing ideas and information.
  • Ensure all inpatient files are available for daily verification of insurance benefits by printing census.
  • Remove and forward discharged patients’ files to the Business Office where they are processed.
  • Request pre-certification and benefits on all patients, both inpatients and outpatients for surgery.
  • Using DDE, perform verification of Medicare coverage and limits on all Medicare accounts of inpatients.
  • Acquire billing information by verifying Worker’s Compensation accounts and MVA.
  • Contact clinical staff for patient’s clinical information if it is needed by the insurance provider for the admission to be certified.

Writing a resume for the position: A resume is usually requested by employers in considering suitable applicants for a position. To prepare a resume for the post of medical insurance verification clerk, the needed relevant information to make the resume can be extracted from the job description example above.

Requirements – Qualities – Knowledge, Skills, and Abilities – for the Position of Medical Insurance Verification Clerk

To be effective on the job, individuals will need to acquire and develop the following qualities, which are also usually required by most employers for employment consideration:

  • Excellent typing and computer usage skills, including Microsoft Word and Excel proficiency.
  • Ability to relate with people of diverse backgrounds, provide excellent customer service and solutions to problems.
  • Knowledge of drug cards, medical insurance terminology, medical benefits, and billing process.
  • Experience with patient assistance and government programs.
  • Ability to work independently, give attention to detail, prioritize and perform several tasks together without losing concentration.
  • Effective in communicating clearly in writing and in speaking without being misunderstood.