What does an Insurance Verification Specialist do

Insurance verification is vital in the health care industry to make medical care accessible for every individual. However, health care insurance plans come with a huge risk of denied claims or fraud. This makes the insurance verification process quite challenging as it involves documentation and keeps a track of insurance claims for multiple patients. Moreover, insurance claims are directly connected to hospitals’ finances for which it regulates revenue cycle by depending on reimbursements.

To make the verification process hassle-free, efficient and effective it is important to outsource medical insurance verification services from a renowned medical billing company. Focusing on the importance of the verification process the medical billing company provides the hospitals with an insurance verification specialist. But what does an insurance verification specialist do? Why is it necessary to get the assistance of an insurance verification specialist?

Insurance verification is responsible to eliminate any possible risk of denied claims or fraud. He/she is trained to carry out the verification process by following some specific steps involving eligibility and verification, authorization, contacting the patient and submitting claims transmissions. The cycle of verification process requires the insurance verification specialist to perform some duties/tasks.

Insurance Verification Duties/Tasks

Insurance Coverage Verification: An insurance specialist should be aware of all the health care insurance plans offered by various insurance companies. Knowing insurance policies is a prerequisite to make the verification process successful. This knowledge helps in cross-checking the insurance-related information like name of the insurance payer, co-pay, coverage period, member ID, etc.

Handling Payments: The insurance specialist is also required to handle the payments for medical care services excluded from the insurance plan.

Clarifying EOB: He/she has to explain insurance coverage benefits to patients to help them understand the payment split between them and insurance payers.

Obtaining Referrals: This is a kind of pre-approval that allows patients to consult within the hospital’s network.

Patient Record and Follow up: It is imperative to keep track of patients and their insurance claims to get maximum reimbursement and prevent denied claims. Maintaining patient records helps to ease the process of the follow-up.

Documentation for Billing: Since the insurance verification specialist is aware of all the medical care charges, insurance plans, and explanations of benefits he/she can fill the documents required to general the final billing sheet.