Insurance Verification Specialist Resume Sample

4.7
14 votes
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Ima Dibbert
8657 Lucas Landing,  Chicago, IL
+1 (555) 272 1312

Work Experience


Insurance Verification Specialist
05/2016 - PRESENT
Chicago, IL
  • Ensures insurance coverage by telephone
  • Resolves any issues with coverage and escalates complicated issues to manager
  • Interviews patients and completes all paperwork necessary to ensure the admitting process is efficient and all clinic and regulatory policies are in compliance
  • Coordinates with clinical staff to obtain charge information for all patients
  • Codes procedures performed and diagnosis on charge
  • Assigns appropriate ICD-9, CPT and HCPCS code(s) to accurately support the need and documentation for each service
  • Coordinates copies of medical documentation with physician charges to support billing to third-party payers
  • Identifies physician services provided but not accurately documented in the medical record
  • Resolves routine patient billing inquiries and problems
Senior Insurance Verification Specialist
12/2012 - 11/2015
Detroit, MI
  • Experience working in the healthcare industry or accounts receivable field
  • Verifies new and existing patients have necessary referral and/or authorization documentation prior to examination date
  • Verifies patient demographics and insurance providers, updates information in systems, and documents conversations
  • Demonstrate knowledge of state & federal collections guidelines
  • Experience in medical billing, medical insurance verification, managed care and/or patient registration required
  • Demonstrates knowledge of health insurance plans including Medicare, Medicaid and commercial carriers
  • Consistent professional behavior and ability to handle confidential information
  • Able to work independently, prioritizing and organizing workload effectively to complete tasks within the timeframes delegated
  • Contact insurance companies to verify primary and secondary insurance coverage for both in-network and/or out of network physical therapy benefit coverage
Insurance Verification Specialist GYN
03/2009 - 11/2012
San Francisco, CA
  • Obtain the initial prior authorizations/pre-certifications as required by patients’ insurance/plan
  • Provide clear and concise documentation of all calls and benefits information into the current billing system
  • Coordinate information from the patient, clinical staff, front office staff, physician’s office, and employers as needed to complete the verification process
  • Work the essential queues to ensure all requests are resolved and errors corrected in a timely fashion
  • Support the Authorization or Central Referral Intake Departments as requested by management
  • Contact patients with their benefits if required in your market
  • Work within a high volume environment with an emphasis on quality assurance

Education


Everest University - Clearwater Campus
2005 - 2009
School's Degree in Healthcare

Professional Skills


  • Exceptional customer service skills and organizational skills
  • Strong customer service skills – Experience providing customer service to internal and external customers
  • Strong follow-through skills while maintaining high productivity
  • Good multi-tasking and strong verbal & written communication skills
  • Health and/or medical benefits verification skills including major medical and pharmacy benefits experience required
  • Excellent computer, multi-tasking and phone skills
  • Demonstrated ability to provide clear and professional verbal/written communication skills

How to write Insurance Verification Specialist Resume

Insurance Verification Specialist role is responsible for customer, research, microsoft, basic, database, computer, health, excel, retail, training.
To write great resume for insurance verification specialist job, your resume must include:

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

Contact Information For Insurance Verification Specialist Resume

The section contact information is important in your insurance verification specialist 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 Specialist Resume

The section work experience is an essential part of your insurance verification specialist 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 specialist 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 specialist position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions.

Representative Insurance Verification Specialist resume experience can include:

  • Demonstrate the skills needed to ensure exceptional customer service to maximize a positive experience for patients, providers and fellow co-workers
  • Insurance verification experience (or Pharmacy Technician experience or experience in Specialty Pharmacy)
  • Proven mathematical skills
  • Troubleshooting and problem solving skills to assess and solve complex situations
  • Working 10-key and/or keyboarding skills
  • Proficient computer skills, with emphasis on Microsoft Office suite, including Excel

Education on an Insurance Verification Specialist Resume

Make sure to make education a priority on your insurance verification specialist 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 specialist 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 Specialist Resume

When listing skills on your insurance verification specialist 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 specialist skills:

  • Demonstrate good problem-solving skills
  • Excellent customer service skills and professional telephone etiquette
  • Computer skills in outlook, Word, and Excel. Access database experience is highly desired
  • Good computer skills/knowledge
  • Solid time management, organizational skills, and the ability to multi-task are necessary
  • Strong computer skills, especially Microsoft Office (Word and Excel) is required

List of Typical Experience For an Insurance Verification Specialist Resume

1

Experience For Senior Insurance Verification Specialist Resume

  • Performs training with organizational staff on procedures for requesting, documenting and processing prior authorizations
  • Strong background in working denials
  • Review medical documents and patient information to ensure insurance criteria is met prior to processing order
  • Experience in healthcare or pharmacy setting
  • Experience in healthcare field, customer service, telemarketing, or call center environment required
2

Experience For Central Insurance Verification Specialist Resume

  • Related experience with insurance benefit verification in a healthcare setting
  • Insurance Verification experience in pharmacy provider, MD Office, or comparable healthcare provider organization
  • Insurance verification, prior authorizations, and pre-certifications
  • Contacts insurance plans to obtain prior authorization for services
  • Processes request for prior authorization from clinics and Patient Care Coordinators
  • Prioritizes work to maximize turn-around time
3

Experience For Insurance Verification Specialist GYN Resume

  • Communicating/coordinating requirements and criteria regarding a patient's insurance to the billing & clinical departments
  • Working directly alongside financial counselor
  • Processing facility and professional claims
  • Following up with patients and insurances on denied claims
  • Auditing open A/R reports
  • Obtaining authorizations online and over the phone
  • Working in an EMR system
  • Estimating benefits coverage and patient out of pocket costs
  • Contacting insurance companies to confirm insurance coverage and eligibility of devices based on CPT codes
4

Experience For Medical Insurance Verification Specialist Resume

  • Pre-registering patients over the phone and finalizing registration when they get into facility
  • Maintain regular communication and follow-up with program and department contacts regarding pending insurance, coverage and other payment-related issues
  • Forward supporting documentation to staff in registration, patient accounting, and clinical areas, as applicable
  • Supervise aspects of particular patient accounts, including billing and reimbursement
  • Have working knowledge of the following computer programs
5

Experience For Insurance Verification Specialist Acacia OB Resume

  • Inaccurate or missing information is corrected and input into computer system
  • Responsible for verifying all insurance for all types of patients for which a financial chart is created
  • Enter proper diagnosis and missing patient data into company systems
  • Activate patients within the billing system
  • Receive and process proper paperwork for billing purposes and for new cases
  • Verify, interpret, and document patient health insurance or payment source, ensuring complete and accurate information is entered into the system
6

Experience For Insurance Verification Specialist Resume

  • Evaluate eligibility for alternate sources of financing care and refer to appropriate agency where possible
  • Responsible for maintaining specialty clinics and specialty financial classes
  • Comprehensive knowledge of medical billing
  • Assists in maintaining manuals logs and other required documentation as required
  • Re-verify existing patient insurance coverage
  • Work with the Patient Accounts Credentialing Coordinator to resolve patient benefit issues as it relates to payer contracts
7

Experience For Senior Insurance Verification Specialist Resume

  • Answers patient questions, inquires and concerns regarding their benefits
  • Develop and maintain knowledge of individual payer billing and authorization requirements
  • Verify information on incoming documents for accuracy and completeness
  • Willingness and ability to participate in all required training programs
  • Work independently to meet objectives. Ability to meet deadlines
  • Run a variety of computer reports to obtain information and verify data
8

Experience For Central Insurance Verification Specialist Resume

  • Verified insurance information is input into computer system
  • Notify appropriate stakeholders of verified and corrected information
  • Clear and concise written and verbal communication required
  • Use Microsoft Office Suite (Word/Excel/Outlook/Power Point), medical software, insurance payer portals, and type 40+WPM
  • Commercial and government insurances
  • 150-200 accounts per month
  • Work with government and commercial payers and payer guidelines
  • Communication with insurance via phone/website, follow-up with insurance companies, and providing certain types of information and forms as requested to insurance companies
9

Experience For Insurance Verification Specialist GYN Resume

  • Receives, verifies, and tracks insurance authorizations for in-office care
  • Job requires extensive time on phone and provider websites daily
  • Acquire information from various referral sources necessary to bill and collect for services rendered
  • Verify that all of the patients information uploaded is correct and accurate
  • Communicate information to the surgeon’s office to ensure requested information is completed accurately and returned to us in a timely manner
  • Maintain assigned reports on a daily basis
10

Experience For Medical Insurance Verification Specialist Resume

  • Estimate self-pay portions after benefits have been determined (deductibles, co-pays, non-covered services, etc.)
  • Maintain regular communication/correspondence/follow up with patients and families to keep them informed of clearance and self-pay issues
  • Create and maintain positive, knowledge-sharing and collegial working environment and set high work and ethical standards by providing direction and support to staff and customers
  • Secure necessary insurance and patient demographic information while following HIPPA laws. Verify and enter appropriate insurance into billing system to bill for services
  • Manage follow-ups to patient accounts to obtain insurance information
  • Follow department procedures to notify Leadership and update the system with new Payor information
  • Review and resolve any transports on assigned Team reports
  • Send notice of money owed to insurance companies and patients
  • A real talent for the explanation of benefits (EOBs)

List of Typical Skills For an Insurance Verification Specialist Resume

1

Skills For Senior Insurance Verification Specialist Resume

  • Problem-solving skills to research and resolve discrepancies,
  • Interact effectively with a diverse population to obtain needed information
  • Previous Insurance Verification experience required, specifically prior authorizations
  • Experience providing patient communications and financial counseling for a healthcare provider, preferably in a call center environment
  • Obtain & verify appropriate insured, policy, claim and billing addresses of each payer and patient eligibility prior to billing
2

Skills For Central Insurance Verification Specialist Resume

  • Experience performing benefit verification and authorizations required
  • Demonstrated critical thinking and ability to analyze information and problem solve
  • Strong written, verbal and electronic communications
  • Demonstrated ability to complete work with a high level of detail and accuracy
  • Prioritize tasks and complete assignments competently and in a timely manner
  • Request/setup authorizations for required procedures prior to patients visit
3

Skills For Insurance Verification Specialist GYN Resume

  • Experience with insurance verification and eligibility
  • Experience with front-end workflow and processes
  • Out-of-network and private group medical practice experience
  • Understanding and knowledge of HIPPA laws as related to verification guidelines
  • Establishing payment arrangements with attorneys
  • Provide information to referring/rendering physician offices and network service providers regarding program requirements
  • Basic knowledge of accounting, word processing and spreadsheets
  • Follow up on Miscellaneous/Pending accounts/charges and update in billing software in a timely manner
4

Skills For Medical Insurance Verification Specialist Resume

  • Able to work in a team environment - Enhances department by accepting ownership for accomplishing new and different tasks.
  • Manage all insurance verification for new patients and existing patients who have a change in insurance during course of care
  • Work independently within a team setting
  • Proficient with Microsoft Suite, including Word and Outlook
  • Contact referring physician, attorneys, insurance companies and patients as necessary
  • Accurately updates data in microsoft excel and billing software in a timely manner
  • Review check requests, invoices and expense reports for proper documentation, approval authorization, internal controls and proper tax recording
  • Assess the soundness of general ledger coding and vendor purchases
  • Communicates benefits, potential financial responsibility, available financial assistance and provides financial counseling to patients
5

Skills For Insurance Verification Specialist Acacia OB Resume

  • Communicate and resolve patient questions regarding insurance or benefits
  • Zero time off during peak season (Nov – Mar)
  • Enter demographic and screening information from a requesting physician office or provider via telephone or web-based input into the pre-authorization computer system
  • Demonstrated ability to prioritize and manage a large workload in stressful situations
  • Provide professional and courteous customer service while communicating with insurance companies, facilities and referring doctors’ offices
  • Obtain insurance verification, authorization, and precertification for physician, DME, injections, and MRI
  • Contact insurances via phone and online insurance payer portals
  • Provide superior high volume patient customer service in a fast paced environmen
  • Knowledge of Microsoft Office Suite (Word/Excel/Outlook/Power Point), medical software and insurance payer portals
6

Skills For Insurance Verification Specialist Resume

  • Familiarity with human anatomy and medical terminology
  • Maintain department quality and efficiency standards
  • Review accounts for accuracy
  • Answer or direct attorneys, physician, insurance or patient telephone inquiries
  • Knowledge of computer & Microsoft Excel
  • Knowledge of medical and insurance terminology
  • Medical insurance verification REQUIRED
  • Read, review, and understand EOBs
  • Process check requests, invoices and expense reports
7

Skills For Senior Insurance Verification Specialist Resume

  • Attains correct benefit information from insurers
  • Follow-up with patients who have out-of-pocket costs
  • Performs accurate and timely verifications and entry into the Cerner system
  • Contributes to the overall team efforts
  • Reviews demographic and insurance information in patient
  • Enters information into Excel spreadsheet to track accounts
  • Specialty/Department/Practice – Access Service
8

Skills For Central Insurance Verification Specialist Resume

  • Location/Facility – Bryan Tower, Dallas, Texas
  • Location/Facility - Bryan Tower, Dallas, Texas
  • Work M-F, 7-6PM (40 hours a week)
  • Work is specifically specialty – insurance provider, blues plan
  • Contact referral source, patient, and/or doctor’s office to obtain additional information that is required to complete verification of benefits
9

Skills For Insurance Verification Specialist GYN Resume

  • Verify and document insurance coverage of medications, administration supplies and related pharmacy services including prior authorization requirements and coordination of benefits
  • Notify doctor’s office if a prior authorization is required; fax forms to the doctor’s office for completion
  • Place outbound/inbound calls to patients or doctor’s offices to notify of any delays due to more information needed to process or due to a prior authorization
  • Prior experience working with computer programs
  • Experience and proven success in working knowledge of financial processes, policies and procedures
  • At least one year insurance verification and/or pharmacy technician experience OR at least 6 months specialty pharmacy experience
  • Verify benefits coverage for patients by validating insurance provider and coverage using on-line systems
  • Min. 1 year of previous experience in a hospital patient accounting, physician medical billing, insurance verification, healthcare etc
10

Skills For Medical Insurance Verification Specialist Resume

  • Previous experience using a personal computer and various software applications, including, (Microsoft, Excel etc)
  • At least one year of pre-cert experience, including obtaining benefits electronically and/or over the phone
  • Demonstrates an understanding for patient confidentiality to
  • Nurture/foster strong supporting relationship with every physician’s offices
  • Demonstrates support for the Tenet Corporate Compliance Program by being knowledgeable of compliance responsibilities as expressed in the Code
  • Experience verifying insurance benefits (on-line websites)

List of Typical Responsibilities For an Insurance Verification Specialist Resume

1

Responsibilities For Senior Insurance Verification Specialist Resume

  • Detail-oriented, strong work ethic, and committed to a long-term career opportunity
  • Normally requires one (1) to two (2) years directly related and progressively responsible experience
  • 1+year of work experience in a health care related/insurance related field
  • One to three years insurance verification experience
  • Basic skill level in Microsoft Excel, Microsoft Word, Internet explorer
2

Responsibilities For Central Insurance Verification Specialist Resume

  • Basic Skill level in Microsoft PowerPoint
  • In experience in a call center
  • Computer experience, Excel, Word, Medical Applications
  • Demonstrated knowledge of insurances
  • Experience with medical insurance/benefits verifications via phone to insurance companies to obtain coverage, benefits & eligibility information
  • Strong knowledge of Managed Care contracts
  • Strong knowledge of Government and State medical plans
  • Past medical-surgical experience
  • Contacts insurance plans to determine eligibility and obtain coverage and benefit information
3

Responsibilities For Insurance Verification Specialist GYN Resume

  • Documents findings thoroughly and accurately
  • Meets or exceeds productivity standards in the completion of daily assignments and accurate production
  • Maintain an error rate in accordance with departmental policy
  • Makes changes to demographic information as necessary in order to produce a clean patient statement
  • Answer and respond to external and internal phone calls in a timely manner
  • Check and respond to emails in a timely and professional manner
4

Responsibilities For Medical Insurance Verification Specialist Resume

  • Verify patient insurance coverage for national Chiropractic and Physical Therapy clinics through online and call center resources
  • Enter information into EMR and relay back to field in set time parameters
  • Answer inquires on patient accounts through our corporate call center
  • Ensures all insurance, demographic, and eligibility in formation is obtained and entered into the system in an accurate manner
  • Input claims status and reasons why claim was denied
  • Location/Facility – Baylor Scott & White Corporate Offices- Dallas
5

Responsibilities For Insurance Verification Specialist Acacia OB Resume

  • Location/Facility – Baylor Scott & White Health Corporate- Downtown Dallas
  • Responsible for the timely verification of medical insurance benefits for the service scheduled or service being provided via website and/or calling the payer (Managed Care payers, Governmental/State payers, Commercial payers, Workers Compensation, Motor vehicle accident cases)
  • Contact insurance companies to verify primary and secondary insurance coverage for both in-network and/or out of network benefits
  • Verify co-pays, deductibles, high deductible plans, co-insurance, capitations, covered/non-covered services/products, services/product limitations and notates in practice management (PM) system. Discuss with patient and appropriate office staff
  • Document clear and concise benefit information into the PM system
  • Coordinate information to the patient, clinical staff, front office staff and billing staff to complete the verification process. This includes coordination of benefits
  • Work with Patient Accounts Collection Specialists to set up payment arrangements for non-covered/high deductible services
  • Spend long periods of time on the phone with insurance company representatives to obtain needed detailed benefit information
  • Obtain single patient agreements with payers for non-contracted services
6

Responsibilities For Insurance Verification Specialist Resume

  • Work with the Referral Authorization Coordinator to ensure necessary referrals, pre-certification and/or authorizations for scheduled services are obtained and on file
  • Review and resolve preauthorization/precertification/referral issues that are not valid and contact insurance companies to verify/validate requirements to ensure accuracy and avoid potential billing denials
  • Carefully research patient benefits with health exchanges and communicate with patient, Manager of Patient Accounts, billing staff and medical providers prior to scheduled appointments
  • Demonstrate knowledge of accurate account information to produce prompt payer reimbursement
  • Demonstrate flexibility in work shift to meet department needs
  • 6 months relevant work experience
  • Surgical hospital experience
  • A/R experience
  • Assist billing department with reimbursement appeals for denied claims
7

Responsibilities For Senior Insurance Verification Specialist Resume

  • Promptly respond to all written communications
  • Promptly respond to all phone calls, voicemails and e-mail
  • Verify primary/secondary payer protocol and seek pre-authorizations as required
  • Meet daily production goals as directed by management
  • Attend all Insurance Verification Team meetings, as required
8

Responsibilities For Central Insurance Verification Specialist Resume

  • Understand their role and impact they have in the departmental team; including exhibiting positive attitudes, willingness to help wherever asked, staying focused and on task to the matter at hand, and being part of the success of your team
  • Contact insurance providers to verify benefit coverage
  • Scan and upload documents from insurance providers into electronic records system and notify appropriate departments
  • Perform constant data entry and phone work
  • Knowledge of required documentation which can include; LMN’s, Clinical notes, Pedigree’s
  • Commercial and government accounts
  • Facilitates pharmacy and/or major medical claims with insurance companies and practitioner offices, investigates, and facilitates prior authorization any other insurance rejections
9

Responsibilities For Insurance Verification Specialist GYN Resume

  • Basic computer skills (use of Word, Excel, Outlook, etc.)
  • Facilitate and complete the Prior Authorization process with insurance companies and practitioner offices
  • Utilize all available resources to obtain and enter insurance coverage information for ordered services into patient’s file
  • Verify patient insurance coverage of medications, administration supplies and related pharmacy services
  • Complete a full Medical Verification for all medications, administration supplies and related pharmacy services
  • Regular, punctual attendance
10

Responsibilities For Medical Insurance Verification Specialist Resume

  • Accuracy in data entry
  • Extensive knowledge insurance type coverage and policies
  • Familiarity with ICD-10, CPT code, and medical terminology
  • Knowledge of online insurance verifications is necessary
  • Chiropractic and Physical Therapy knowledge base
  • The ability to work well under pressure (most of the paperwork is time sensitive)
  • Work up to 15 hours Overtime, Holidays as needed
  • Medical and Pharmacy benefit knowledge
  • Maintain insurance authorizations for new and current patients

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