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An insurance verifier collects information about patients’ insurance policies, prepares invoices, and processes claims. They may also communicate with insurance companies and patients to discuss changes in coverage and pre-approval for medical procedures. Good communication skills and the ability to work with people from diverse backgrounds are important.
An insurance verifier works with insurance claims in a medical practice to facilitate the process and collect payments in a timely manner. It is often necessary to familiarize yourself with insurance billing and coding systems, electronic medical records and privacy practices. The work environment is similar to that of other office jobs, although there is also a customer service aspect to it because insurance adjusters work directly with patients. This may require good communication skills and the ability to work with people from diverse backgrounds.
When patients enter a clinic or hospital system, the insurance verifier collects information about their insurance policies. This information can help providers determine whether specific treatments and procedures are covered. Insurance verifiers can prepare invoices for insurance companies using their coding systems and process claims as they move through the office. If insurance refuses to pay a claim, the insurance verifier may appeal, or may work with the patient to file an appeal if the practice does not handle it.
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 latest information is available. Errors in a file can result in issues such as sending an invoice to the wrong company or using incorrect file numbers that result in late payment. If patients lose insurance coverage, this can also be important information for the medical practice.
In cases where pre-approval is required for medical procedures, the insurance verifier can prepare and submit this documentation. This can also include phone calls to insurance companies in situations where caregivers and patients want immediate information about coverage. For example, a patient may want to wait for a test if it is not covered, or a healthcare professional may 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 for 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 caregivers are unable to offer treatment due to concerns about ability to pay, this can involve tense or unpleasant conversations. The ability to remain calm, professional and friendly in such environments is critical to success in this job.
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