Insurance Verification Resume Sample

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Joseph Ebert
5843 Jacobson Row,  Phoenix, AZ
+1 (555) 350 2375

Work Experience

Insurance Verification Team Lead
12/2017 - PRESENT
Philadelphia, PA
  • Reporting of any system issues/ glitches in a timely manner after research through the proper channels
  • Ensures all insurance requirements are met prior to patients’ arrival. Calculates and estimates patient charges and documents estimated patient financial liability (insurance limits and co-payment responsibilities) prior to arrival for services
  • Obtain patient’s benefit information
  • Verify insurance benefits according to protocol
  • Correspond closely with Scheduling Coordinator to ensure all scheduled patients, including add-ons, have completed insurance verification
  • Calculate patient’s estimated co-pay or co-insurance amounts, based on benefits information supplied by the insurance company
  • Place a sticker on the front of the patient’s chart, indicating amount of payment to be collected by the Admitting Clerk on the day of surgery
Insurance Verification Representative
04/2012 - 11/2017
San Francisco, CA
  • Telephone the patient prior to the day of surgery to inform them of payment amount due on the day of surgery, if that amount exceeds $100
  • Prepare promissory note to be signed on the day of surgery if the patient is self-pay
  • Ensure that correct insurance information is entered into the computer system and enter any other comments, as necessary
  • Correspond closely with the billing office, to inform them of any special accommodations or problems associated with a patient’s bill
  • Ascertain insurance information from patient’s prior to service
  • Initiates the verification and pre-authorization process for Anne Arundel Medical Group with insurance carriers. Contacts insurance companies, referring physicians and patients, according to department policies and procedures
  • Accesses payer on-line tools to verify patient insurance coverage and authorization information when applicable
  • Enters pre-authorization information into the Revenue Cycle system in the designated computer screens to prevent denials. Identifies insurance carriers/procedures requiring special referral forms, according to departmental policy
  • Provides support/assistance to practice and billing department, Revenue Cycle and/or billing vendor in the resolution of verification or authorization issues
Insurance Verification Rep
02/2009 - 02/2012
Chicago, IL
  • Attends staff meetings, in-services, insurance payer meeting or web-based training. Utilizes updated Insurance Matrix information
  • Demonstrates effective communication skills, both verbal and written. Computer experience
  • Collects and documents accurate patient demographics and insurance information
  • Obtains all prior authorizations as appropriate based on insurance plan contracts / guidelines and documents in EPIC system per policy and procedure
  • Enters and updates referrals as required
  • Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage and payment for specific patients and benefits
  • Notifies families of insurance limitations or potential out of pocket costs for requested services
  • Facilitates referral to Financial Services for payment sources for uninsured patients


University of Phoenix - Vancouver Learning Center
2003 - 2008
Bachelor's Degree in Management

Professional Skills

  • Computer skills, typing skills and great customer service skills are needed
  • Excellent typing and computer usage skills, including Microsoft Word and Excel proficiency
  • Strong follow-through skills while maintaining high productivity
  • Excellent customer service skills in a fast paced changing environment
  • Strong knowledge and understanding of ICD-10, HCPCS, and CPT coding, and experience with medical billing and collections terminology
  • Proficient computer skills, with emphasis on Microsoft Office Suite, including Excel
  • Proficiency in basic computer skills, including the ability to maneuver within a Microsoft Windows

How to write Insurance Verification Resume

Insurance Verification role is responsible for computer, customer, excel, microsoft, basic, insurance, word, typing, multitasking, health.
To write great resume for insurance verification job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Insurance Verification Resume

The section contact information is important in your insurance verification resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:

  • First and last name
  • Email
  • Telephone number

Work Experience in Your Insurance Verification Resume

The section work experience is an essential part of your insurance verification resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous insurance verification responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular insurance verification position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions.

Representative Insurance Verification resume experience can include:

  • Schedules and assists with coordinating appointments for multiple disciplines and with outside vendors as appropriate by program. Registration Functions (including but not limited to)
  • Interact effectively with a diverse population to obtain needed information
  • Communicate clearly and effectively in both verbal and written form
  • Experience pre-registering and registering patients, entering demographic data, and scheduling patient appointments
  • Effective in communicating clearly in writing and in speaking without being misunderstood
  • Desire previous scheduling or related healthcare oriented work experience dealing with patients, referring physicians and healthcare providers

Education on an Insurance Verification Resume

Make sure to make education a priority on your insurance verification resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your insurance verification experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.

Additional details to include:

  • School you graduated from
  • Major/ minor
  • Year of graduation
  • Location of school

These are the four additional pieces of information you should mention when listing your education on your resume.

Professional Skills in Insurance Verification Resume

When listing skills on your insurance verification resume, remember always to be honest about your level of ability. Include the Skills section after experience.

Present the most important skills in your resume, there's a list of typical insurance verification skills:

  • Strong verbal communication skills to communicate effectively with patients over the phone
  • Dependable, self-starter, and detail oriented with great organizational skills and the ability to effectively prioritize work on a daily basis
  • Strong attention to details and critical thinking skills. Ability to make decisions based on insurer and program criteria
  • Detail oriented, self motivated, and strong multitasking skills
  • PC skills - demonstrates proficiency in Microsoft Office applications and others as required including: Outlook, Excel and internet navigation
  • Able to effectively communicate in English, both verbally and in writing, additional languages helpful

List of Typical Experience For an Insurance Verification Resume


Experience For Insurance Verification Representative Resume

  • Builds relationships with current and new physicians by resolving issues, communicating effectively and efficiently managing patients
  • Experience utilizing a computer and Microsoft Office (Microsoft Word, Microsoft Excel, and Microsoft Outlook) to create, copy, edit, send, and save documents
  • Verify insurance prior to patient’s surgery or procedure
  • Eligibility determination & benefits experience
  • Relate with people of diverse backgrounds, provide excellent customer service and solutions to problems
  • Experience with patient assistance and government programs
  • Preparing medical records for scanning process by ensuring all documentation relates to each patient and is the appropriate size to be scanned

Experience For Insurance Verification Rep Resume

  • Understanding and using more than nine computer systems in order to work efficiently
  • Verifying that all records were scanned and if any date of service for assigned facilities was not received
  • Assists the Operations Director, Behavioral Services in evaluating and improving verification processes and work flows as appropriate
  • Requests picture ID 100% of the time during initial check-in of evaluation
  • Alerts clinical staff of patient arrival and communicates with clinical staff as to the status of patients waiting more than 10 minutes after scheduled visit

Experience For Insurance Verification Team Lead Resume

  • Accurately records status of therapy appointments, differentiating no-show versus cancellation etc
  • Handles triage of “walk down “appointments for scheduling and insurance approvals
  • When the patient’s insurance is Out of Network notify the manager immediately. Follow the Policies and Procedures when accepting Out of Network payers
  • Perform insurance verification according to SCA standards and guidelines
  • Document benefit verification and pre-certification in patient accounting system
  • Works closely with referring physicians' staff to obtain patient notes and begin process of authorizations
  • Manage and Support a non-exempt staff who are responsible for verifying demographic
  • Monitor workflow daily, identifying any courier/ system issues

Experience For Insurance Verification Coordinator Resume

  • Attends and participates in departmental staff meetings. Reads and reviews email, departmental meeting notes when not in attendance
  • Contact referral sources and patients to discuss any problems or delays encountered during insurance verification
  • Assist patients and referrals in finding an alternative provider with MPCS is not contracted with the insurance
  • Precertification Specialist is responsible for contacting insurances via phone and online insurance payer portals
  • Lists and verifies primary and secondary insurance, including claims address
  • Anticipates potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify

Experience For Insurance Verification Lead Resume

  • Work requires a comprehensive understanding of insurance pre-certification requirements, contract
  • 14 Maintains confidentiality of information acquired pertaining to patients, physicians, employees and visitors
  • Verify insurance cards and other important documents (real-time)
  • Collects and posts co-pays, any past due balances, and reconciles money at the end of the shift, as required by program
  • Achieve a daily “after visit” verification (insurance and demographics) percentage of => 95%
  • Interfacing with customers, physicians and referral sources as required in order to process an order shipment, as well as follow up on outstanding/pending orders
  • Records the appropriate information in information systems and completes daily weekly and monthly reports as required

Experience For Escalated Insurance Verification Resume

  • Medicaid and other government contracts and guidelines and workmen’s compensation fee schedule
  • Under general supervision and utilizing functional knowledge and expertise, verifies and documents patients’ insurance information and eligibility per company requirements and department standard operating procedures ensuring completeness and accuracy to facilitate timely and accurate billing and collections activities
  • Communicate financial responsibility to patients, surgeon’s office and team members
  • Communicate with insurance companies for the purpose of collecting and documenting information necessary to financially clear patients (eligibility, authorization, benefits, and calculate patient liability calculations)
  • Coordinates with insurance providers and departments to obtain referrals and pre-authorization, documents these findings into the appropriate system(s)
  • Accurate verification of customer insurance benefits via phone or web
  • Entry/update of deductible, copay, coinsurance or out of pocket accumulations

Experience For Senior Supervisor Integrated Collections & Insurance Verification Resume

  • Verification of coverage of supplies ordered
  • Verification of network participation with the customer's insurance plan
  • Oversee insurance verification staff
  • Calculate estimated patient responsibility
  • Contact patient via phone and go over benefits and estimated portion due
  • Communicate with hospital managers per internal protocol
  • Assist manager with special projects and audits

Experience For Patient Insurance Verification Coordinator Resume

  • Utilizes telephone voice response systems and website solutions to obtain information on patients' eligibility status with insurance companies
  • Investigate and resolve EREGI problems for clients
  • Monitor daily inventory and production to ensure all clients are moved evenly
  • Monitor correction queue and provide support to staff for resolution to problems
  • Responsible for monthly closeouts for clients, and address system problems

Experience For Scheduler / Insurance Verification Resume

  • Obtain authorization for home health care services for new patients whose insurance requires authorization for services
  • Track authorizations for patients whose health care insurance requires authorization
  • Obtain retro-authorizations as needed
  • Obtains insurance eligibility and benefit information using various phone and on-line resources. Maintains appropriate authorizations and notifies insurance companies of patient arrival as needed. Ensures eligibility and authorization requirements are completed within the required timeframe
  • Ensures clinically appropriate documentation is received timely from medical providers / facilities, to ensure medical necessity is appropriate for type of services being provided. Ensures reauthorization functions are completed in a timely manner, based on individual payer requirements
  • Performs translation of narrative diagnoses provided by physicians into appropriate ICD-9 codes
  • Ensures ongoing eligibility based on clinical documentation for medical necessity. Ensures written order from ordering physician is received, signed, and dated appropriately prior to allowing the account to move to billing (regulatory HC requirement)

Experience For Spec Insurance Verification Resume

  • Collaborates with clinicians and intake managers to minimize risk associated with medical necessity / financial sponsorship changes that affect the reimbursement. Makes appropriate corrections in the patient's record to ensure accuracy in order to prevent denials and/or problems with billing and reimbursement
  • Estimates cost of service using ICD-9 or CPT codes. Performs calculations using insurance benefit information to accurately estimate patient responsibility. Analyzes patient / guarantor's previous account history to guide financial conversation
  • Develop and manage relationships with payors, providers, independent co-pay foundations, alternative funding outlets, etc. to increase the probability of prescription access and fulfillment
  • Partner with commercial teams within established guidelines and working relationships to ensure reimbursement center operations are aligned with consumer and professional marketing initiatives to create customer-focused operational efficiencies that maximize patient acquisition and retention
  • Medical office experience required
  • Validate and Log PO/RX/CMNs and PARs as needed
  • Strong proficiency with Microsoft Office Suite (Word/Excel/Outlook), insurance payer portals, electronic medical records (EMR) software
  • Understand and adhere to the Code of Business Conduct, Operating Guidelines as well as appropriate IRS, CMS, HIPAA, and OIG guidelines

List of Typical Skills For an Insurance Verification Resume


Skills For Insurance Verification Representative Resume

  • Oral communication skills to speak clearly and distinctly in English, using appropriate vocabulary and grammar
  • English writing skills to prepare grammatically correct business documents
  • Experience in developing, implementing, and follow through on newly established (or updates to existing) policies, procedures, and workflows
  • Demonstrated knowledge of general business operations, scheduling, insurance, and coding
  • Demonstrated proficiency in typing and data entry using MS Excel/MS Word/10-Key pad by touch
  • 8 Provides information to patients concerning hospital policies and regulatory requirements, utilizing effective
  • Minimizes third party payer denials by verifying authorization of service, prior to forwarding patients to service delivery areas

Skills For Insurance Verification Rep Resume

  • Experience with insurance contracting/provider relations. (i.e. payor regulations, managed care and compliance)
  • Contact physician to resolve issues regarding prior authorization or referral forms
  • Experience obtaining pre certification
  • Work independently, give attention to detail, prioritize and perform several tasks together without losing concentration
  • Experience in a medical office
  • Strong written, verbal and electronic communications
  • Experience in medical office
  • Experience in a small group practice

Skills For Insurance Verification Team Lead Resume

  • Centricity Practice Management / EMR experience
  • Knowledge and experience in payor contract negotiations and management of payor contracts
  • Prioritize work, handling multiple tasks to completion within the time allotted
  • Provides point –of – service information and logistics to ensure an exceptional patient experience
  • Prioritize and manage tasks simultaneously

Skills For Insurance Verification Coordinator Resume

  • Performs insurance pre-certification, verification, interviews patients prior to surgery, and documents information accordingly
  • Verifies all patient eligibility, authorizations, benefits, claim information with insurance companies, and 3rd party payers prior to surgery
  • In lieu of on-the-job experience---
  • Third party claims management experience in a multiple payer environment in the healthcare industry
  • Healthcare experience, in either a provider or payor site
  • Registrar and third party payor experience

Skills For Insurance Verification Lead Resume

  • Experience in hospital insurance verification
  • Insurance verification experience, preferably in a hospital setting
  • Maintaining accurate daily input of medical record data into a Billing Management System in a production environment by keying and/or scanning the data
  • Applying insurance codes in the billing system according to appropriate financial classes
  • Maintaining a deep understanding of all major insurance plans and products
  • Understanding of the medical billing process
  • Answering incoming calls and emails

Skills For Escalated Insurance Verification Resume

  • Running reconciliation reports and performing daily reconciliation for each date of service/facility that is received
  • Scanning authorization requests, approvals ect into imagining in Intergy
  • Contributing to Team Success–Actively participates as a member of the CBO’s team to move the team toward the completion of goals
  • Reviewing account and payment activity
  • Maintaining daily/weekly/monthly production deadlines and demands
  • Training staff on new clients/states and verification processes

Skills For Senior Supervisor Integrated Collections & Insurance Verification Resume

  • Staying up on insurance verification processes
  • Communicates with center leadership team regarding scheduling issues. Keeps center team informed of changes affecting the schedule
  • Maintains a thorough knowledge and understanding of current billing and pre-certification requirements for all areas of Third Party/Special Billing
  • Responsible for updating patient's benefit information in eRAD RIS (EHR System) and verify the accuracy of the existing insurance information in the system
  • Works with patients and referring offices to explain benefit coverage for various diagnostic imaging services

Skills For Patient Insurance Verification Coordinator Resume

  • Provide education to referring offices on what is needed to obtain pre-certification of services for a faster processing time
  • Work closely with insurance providers and referring physician's staff to obtain patient history to expedite processing
  • Proficiency in navigating multiple screens and programs at the same time in order to facilitate problem solving, and other activities
  • Assist with month end reporting and logistical and/or problem resolution related to patient’s medical record, authorization and billing issues
  • Communicate with field staff case manager and scheduling regarding authorization obtained, amounts, date ranges, and limits

Skills For Scheduler / Insurance Verification Resume

  • Closely monitor the billing system Master Files and make necessary updates. Add new doctors and referrals to the billing system
  • Follow all HIPAA, Accreditation and Insurance guidelines during order processing
  • Performs financial counseling, insurance notification, verification and authorization for new and existing patients
  • Thorough knowledge of IDX and medical billing, insurance, and collection practices
  • Interact in a professional, courteous, mature manner promoting BCM's image and prestige
  • Recognizes and Rewards outstanding performance, creativity, and teamwork on a regular basis
  • Analyzes backlogs and implement appropriate solutions, which include communication of the issues and assisting in the resolution
  • Complete Medicare Secondary Payor Questionnaire as applicable for retention in Abstracting module

Skills For Spec Insurance Verification Resume

  • Knowledge of MS Office including Excel and Word
  • Medical record reconciliation reporting, and knowledge of medical insurance and insurance requirements
  • Learn and use electronic billing software
  • General working knowledge of Windows and Microsoft Office
  • Notifies insurance companies of admissions as outlined in existing contracts to ensure appropriate verification of benefits
  • Establishes and maintains file of third party benefit carriers and updates as required ensuring a current, complete file
  • Assists in new employee training as delegated by Manager or Lead
  • Precertification Specialist is responsible for obtaining insurance verification, authorization, and precertification for physician and hospital services

List of Typical Responsibilities For an Insurance Verification Resume


Responsibilities For Insurance Verification Representative Resume

  • Workers comp and commercial insurance experience required
  • Contacting patients to verify insurance details
  • Obtaining retro authorizations in a timely manner
  • Provide recommendations regarding appropriate promotional and business practices based on reimbursement capabilities
  • Provides adequate notes in PAI & MS4 system by documenting insurance information and patient issues

Responsibilities For Insurance Verification Rep Resume

  • General understanding of their role in the revenue cycle
  • Schedules and assists with coordinating appointments for multiple disciplines and with outside vendors as appropriate by program
  • Verification on-line/computer and some phone
  • Manage day-to-day operations to deliver superior customer service and improved access to medication for commercial and uninsured patients
  • Monitor similar industry programs and regulatory guidance to ensure program relevance and compliance
  • Lead and mentor direct reports responsible for reimbursement operations for designated AbbVie products

Responsibilities For Insurance Verification Team Lead Resume

  • Utilize all available resources for optimum achievements (Websites, publications, payer and 21 C payer contracting updates, coding and apply these changes to the workflow
  • Review Office Schedules daily for Patients requiring authorizations, referrals & insurance verification
  • Contact the physicians, FD, FC, RD, Ellen Grasso & your manager when a Peer to Peer is requested
  • Knowledge of medical terminology as well as ICD-9 and CPT codes
  • Verifies insurance benefits on inpatient accounts, short stay surgeries, pre-admissions and outpatient visits

Responsibilities For Insurance Verification Coordinator Resume

  • Obtains authorizations and referrals based on payer medical policy
  • Verifies hospital coverage for short stay surgeries and outpatient visits with insurance companies to ensure accurate verification of benefits
  • Documents insurance benefits and enters into the system
  • Notifies Financial Counselor immediately of inadequate insurance coverage so that appropriate financial arrangements can be made
  • Knowledge of insurance third party payers and use of insurance websites
  • Perform pre-registration, insurance verification, pre-cert/auth, deposit calculation, and telephone collection within 24 hours of receipt of reservation/notification for scheduled services and 48 hours prior to the date/time of the patient’s appointment (when scheduled within 72 hours of appointment)
  • Seeks assistance from financial counselors when needed to maintain patient flow while resolving financial issues. Communicates with financial counselors, or other designated liaisons, when unresolved financial issues pose financial integrity risks

Responsibilities For Insurance Verification Lead Resume

  • Obtain medical documentation from physician’s offices or other healthcare professionals to support the necessity for supplies
  • Utilize the Workflow system to create and route required forms to the patients file
  • Identifies physician services provided, but not accurately documented in the medical record
  • Serves as a program representative for the Bariatric practice
  • Updates IP hospital accounts ensuring that information is accurate and complete, i.e., spelling, demographics, correct abbreviations and punctuation. If needs, contacts patients or family members to obtain correct information. Forwards errors to Admitting Educator
  • Maintains a program in which insurance eligibility and benefits are secured at point of service and prior to discharge. Contacts the insurance company to determine eligibility/benefits and copay/deductibles, LTM

Responsibilities For Escalated Insurance Verification Resume

  • Collects on deductibles, co-insurance, co-pays and out-of-pocket portions owed
  • Ensures correct forms are completed and signed for each registration
  • Ensures insurance eligibilities, notifications, authorizations and other forms are scanned into EDM for ancillary departments, Patient Financial Services, Medical Records, etc
  • Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received
  • Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements

Responsibilities For Senior Supervisor Integrated Collections & Insurance Verification Resume

  • Resubmits claims with necessary information when requested through paper or electronic methods
  • Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels
  • Resolves work queues according to the prescribed priority and/or per the direction of management and in accordance with policies, procedures and other job aides
  • Telephone calls to employers and insurance companies and using electronic communication systems such as Internet sites, computer links, and electronic data exchange software
  • Work closely with the scheduling and patient account services to ensure accurate and timely billing of current accounts and to update internal databases for future registrations
  • Patient Access and/or Insurance Verification experience required
  • Update the registration for patients admitted to the medical center, when necessary
  • Understanding of the complexities of health plans and the relationship between health plans e.g., Medicare, MaineCare, Commercial Insurances, Blue Cross, Worker's Compensations, and self-pay

Responsibilities For Patient Insurance Verification Coordinator Resume

  • Ascertain insurance information from patients prior to service
  • Works collaboratively with clinical staff, Central Business Office, financial counselors etc to assure coverage and payment are obtained for all services rendered
  • Appropriately communicates with a variety of contacts (patients, parents, physician, clinicians, patient relations, translators etc)
  • Verify insurance benefits for Durable Medical Equipment (DME), update teamshare with appropriate DME information, notify clinical staff of any issues with DME benefit, and inform families of any (OOP) out of pocket expenses
  • Assists with unusual, complex or escalated issues as necessary

Responsibilities For Scheduler / Insurance Verification Resume

  • Identification and proper data entry of insurance details
  • Customer service ability to respond to common inquiries from patients, clients or other departments within revenue cycle
  • Previous insurance verification
  • Speak, read, write and understand English
  • Knowledgeable of application regulations and standards affecting Pharmaceutical Products specifically knowledge of HIPAA guidelines and appropriate federal, state, and local regulations applicable to reimbursement and call center operations

Responsibilities For Spec Insurance Verification Resume

  • Knowledge of insurance cards, medical insurance terminology, medical benefits, and billing process
  • Hospital registration, medical office, insurance company-prior authorization, pre-certification, insurance benefits and how it relates to registration
  • – Insurance verification experience in a healthcare setting with previous experience in insurance eligibility, Medicare, AHCCCS/Medicaid, Management Care and Private Pay sources
  • Hospital registration, medical office, insurance company - prior authorization, pre - certification, insurance benefits and how it relates to registration
  • Leadership/ Management experience at least 1 year
  • Follows OSHA regulations, RadNet and site protocols, policies and procedures. Follows HIPAA, compliance, privacy, safety and confidentiality standards at all times
  • Precertification/authorization knowledge with surgery/radiology/inpatient/outpatient/hospital/physician’s office
  • Proficiency in use of computers and software, specifically Microsoft Office
  • Basic knowledge of formulas, charts and tables, and their applications

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