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Verification Representative How to become, career path, income potential

Do you have an interest in health and medicine, a keen eye for details, and enjoy helping people? Then a job as a verification representative might be an excellent career choice for you. 

Medical verification representatives interact with customers — usually via incoming or outgoing phone calls — to answer their insurance-related questions and verify and assist in authorizing their claims. They are also responsible for helping in the overall billing and payment processing, as well as performing administrative duties. Verification representatives work in physician’s offices and other healthcare and wellness facilities.

Sample job description

[Your Company Name] is searching for an outgoing and assertive verification representative. Are you outgoing and conversational? Do you enjoy talking to people and resolving their issues? If so, this position may be the one for you. The verification representative will be responsible for communicating and interacting with clients over the phone, both incoming and outgoing. The ideal candidate will be able to answer insurance-related questions, assist with insurance-related troubleshooting, and authorize any claims needed. They will be responsible for managing any relevant administrative duties as well. This may include processing charges and managing billing systems. If this position sounds like an ideal role for you, please don’t hesitate to apply. We would love to have you on our team!

Typical duties and responsibilities

  • Listen and respond to patient inquiries and concerns regarding health plan benefits, account status, payment history, and medical services
  • Maintain contact with health plan and medical group representatives
  • Provide information about products and services
  • Take orders, calculate charges, and process billing or payments
  • Review or make changes to customer accounts
  • Record details of customer contacts and actions taken

Education and experience

  • High school diploma or its equivalent required

Required skills and qualifications

  • Understanding of medical terminology, insurance collections, and billing
  • Strong written and verbal communication
  • Ability to think independently
  • Excellent interpersonal skills
  • Ability to recognize and manage priorities

Preferred qualifications

  • Bachelor’s degree
  • 4+ years of experience authorizing claims and dealing with insurance
  • Self-starter

Typical work environment

A verification representative will spend their days in a healthcare or wellness facility. They will be in charge of communicating with clients through the phone in an office or call center environment. This will include answering both incoming and outgoing phone calls. As a verification representative, you will be responsible for troubleshooting and solving any insurance problems a client or customer may be having. Your position will oftentimes be full-time between regular business hours. This job requires someone who has good communication and problem-solving skills, as well as a good head for conflict resolution. This is because the verification representative will have to listen, entertain, and respond to any customer questions, problems, or concerns relating to insurance or healthcare plans and services.

Typical hours

The typical work hours for a verification representative are from 9 AM to 5 PM, Monday through Friday, in an office setting. 

Available certifications

A company that is hiring a verification representative will often look for some sort of expertise, experience, or valid certification. Some of the relevant certifications for this position include:

  • Client Service Specialist Certification (CCSS) – The CCSS certification aims to provide an entry-level certification for a client service specialist or company representative. This certification will provide training and testing on proper conflict resolution procedures, customer service procedures, and other relevant topics. This is a great option for individuals in any representative position, especially verification representatives.
  • Certified Customer Experience Professional (CCEP) – Becoming a certified customer experience professional can massively benefit individuals in the verification representative role, as it showcases a good understanding and professional level of skills in regard to customer service and experience.
  • Certified Medical Office Manager (CMOM). The CMOM certification may be relevant to verification representatives due to their potential of dealing with administrative duties in the position. This certification provides pertinent information for medical office management and data entry roles.

Career path

The career path for a verification representative starts by obtaining a high school diploma or GED. While not always necessary, employers often prefer candidates that have earned certification through a professional organization like the American Medical Billing Association. 

US, Bureau of Labor Statistics’ job outlook

SOC Code: 29-2098

2020 Employment335,000
Projected Employment in 2030363,600
Projected 2020-2030 Percentage Shift 9% increase
Projected 2020-2030 Numeric Shift28,600 increase

The healthcare industry is increasing in size each year. More and more people are accessing healthcare services and making insurance claims, which creates a growing need for verification representatives and professionals working in the healthcare billing field.

One reason for this is the aging population in the United States. Older people typically need more medical services than younger individuals. As the oversized baby-boom generation ages, the demand for healthcare services will continue to increase across the board.