Top 11 Insurance Verification Specialist Certifications

Certifications are an important way for insurance verification specialists to demonstrate their knowledge and experience in the field. By obtaining certifications, such as Certified Professional Coder (CPC) or Certified Medical Insurance Specialist (CMIS), individuals can stand out from other job candidates and show employers that they have the necessary skills and qualifications to meet the demands of the position. Additionally, certifications help employers identify qualified professionals who are up-to-date on industry standards and regulations, thus ensuring a high level of accuracy in verifying insurance benefits. Lastly, certifications can provide insurance verification specialists with greater career opportunities, better pay, and improved job security.

The purpose of this article is to provide an overview of the most beneficial certifications for Insurance Verification Specialists and how they can help to advance their career.

What are Insurance Verification Specialist Certifications?

Insurance verification specialist certification is a type of professional certification that recognizes individuals who have demonstrated proficiency in the insurance verification process. This certification is typically offered by professional organizations and certifying bodies, and successful completion of the program can help to demonstrate an individual’s knowledge in insurance verification to employers and other professionals.

Insurance verification specialists are responsible for verifying that a patient’s health insurance coverage is valid before providing medical services. This includes reviewing the information on the patient’s health insurance card, contacting insurance companies to verify coverage, and ensuring that all necessary paperwork is completed correctly. Becoming certified as an insurance verification specialist can help individuals gain recognition for their knowledge and experience in this field, as well as provide them with a competitive edge when applying for positions.

Certification programs typically require applicants to possess a certain level of experience in the industry, as well as pass a written exam covering topics such as medical coding, HIPAA compliance, billing processes and procedures, and customer service. Upon successful completion of the program, individuals will be awarded a professional certificate or designation showing their achievement. As an added benefit, many organizations offer continuing education credits for those who maintain their certification over time.

Overall, becoming certified as an insurance verification specialist can give individuals an advantage when seeking employment opportunities or promotions within the field of healthcare administration and related industries. It also serves to demonstrate an individual’s commitment to advancing their career through professional development activities.

Pro Tip: Make sure to check if the insurance verification specialist certification you are considering is accredited by a reputable organization. Accreditation is important because it ensures that the certification program meets certain standards for quality and content. Additionally, some employers may require that their employees have an accredited certification.

Related: What does an Insurance Verification Specialist do?

Top 11 Insurance Verification Specialist Certifications

Here’s our list of the best certifications available to Insurance Verification Specialists today.

1. Certified Insurance Verification Specialist (CIVS)

Certified Insurance Verification Specialist (CIVS) is a professional certification program for individuals who work in the insurance industry. The program is designed to help verify and validate insurance coverage for clients, employers, and other stakeholders. It provides a comprehensive understanding of the insurance verification process and helps ensure that all parties involved have accurate information about their coverage.

The CIVS certification is offered by the National Association of Insurance Commissioners (NAIC). To become certified, applicants must pass an exam administered by NAIC. The exam covers topics such as insurance policy language, legal requirements, and customer service standards. The exam typically takes two hours to complete and costs approximately $150.

In order to be eligible to take the CIVS exam, applicants must have at least one year of experience working in the insurance industry or have completed a related educational program approved by NAIC. Additionally, applicants must also submit proof of completion of an approved ethics course prior to taking the exam.

Once certified, CIVS professionals are required to complete continuing education credits every three years in order to maintain their certification status. This ensures that they stay up-to-date on changes in the industry and remain knowledgeable about best practices for verifying insurance coverage.

2. Certified Professional Coder (CPC)

Certified Professional Coder (CPC) is a credential offered by the American Academy of Professional Coders (AAPC). It is designed to recognize individuals who demonstrate mastery in medical coding and billing. The CPC requires individuals to have a thorough understanding of the ICD-10, CPT, and HCPCS coding systems.

To obtain the CPC certification, applicants must first pass an exam administered by the AAPC. This exam consists of 150 multiple-choice questions and takes approximately 5 hours to complete. Applicants must also meet certain educational requirements, such as completing a coding program or having two years of professional coding experience.

The cost of the CPC exam varies depending on whether you are an AAPC member or not. For non-members, the cost is $399; for members, it is $299. Additionally, there may be additional costs associated with obtaining any required educational materials or training courses needed to prepare for the exam.

3. Certified Medical Insurance Specialist (CMIS)

A Certified Medical Insurance Specialist (CMIS) is a professional who has completed specialized training and passed an exam to demonstrate their knowledge of medical insurance and billing. The certification is offered by the American Academy of Professional Coders (AAPC).

The CMIS certification requires applicants to have at least one year of experience in medical coding or billing, as well as completion of an AAPC-approved course in medical insurance and coding. The exam consists of 150 multiple choice questions covering topics such as health insurance plans, claims processing, reimbursement methods, and medical coding. It takes approximately three hours to complete the exam.

To get certified, applicants must register with AAPC and pay a fee of $299 for members and $399 for non-members. Once registered, applicants can take the exam at any approved testing center or online through ProctorU. After passing the exam, applicants will receive their CMIS certification within four weeks.

The cost for the CMIS certification includes the registration fee plus any applicable taxes and fees, which may vary depending on the location of the testing center or online proctoring service used.

4. Certified Billing and Coding Specialist (CBCS)

A Certified Billing and Coding Specialist (CBCS) is a professional who specializes in the coding and billing of medical services for insurance reimbursement. They are responsible for accurately coding medical procedures, diagnoses, and medications that are used to submit claims to insurance companies. This position requires knowledge of medical terminology, anatomy and physiology, and the ability to interpret medical records.

The National Healthcareer Association (NHA) offers the CBCS certification exam. To become certified as a CBCS, applicants must have at least one year of experience in medical coding or billing within the past three years or have completed an accredited program in medical coding or billing. The exam consists of multiple-choice questions covering topics such as ICD-10-CM codes, CPT codes, HCPCS codes, E&M guidelines, modifiers, and insurance policies.

It typically takes 4-6 weeks to prepare for the CBCS exam depending on the individual’s level of knowledge. There are many resources available online such as practice exams and study guides to help individuals prepare for the exam.

The cost of taking the CBCS exam is $199 USD which includes a one year membership with NHA upon successful completion of the exam.

5. Certified Professional in Healthcare Risk Management (CPHRM)

Certified Professional in Healthcare Risk Management (CPHRM) is a certification offered by the American Society for Healthcare Risk Management (ASHRM). It is designed to recognize individuals who have achieved a high level of expertise in healthcare risk management. The CPHRM designation is held by professionals who have demonstrated their knowledge and understanding of the principles and practices of healthcare risk management.

The CPHRM program consists of two components: an online course and an examination. The online course covers topics such as legal and regulatory requirements, medical malpractice, patient safety, quality assurance, and risk financing. The exam tests the candidate’s knowledge and understanding of these topics.

In order to become certified, candidates must successfully complete both the online course and the examination within two years. Candidates must also demonstrate that they have at least five years of professional experience in healthcare risk management or related fields.

The cost of the CPHRM program varies depending on whether or not you are an ASHRM member. For non-members, the cost is $1,500 for both the online course and exam; for members, it is $1,200 for both components.

Overall, obtaining your CPHRM certification can be a great way to demonstrate your expertise in healthcare risk management and advance your career in this field.

6. Certified Patient Account Representative (CPAR)

Certified Patient Account Representative (CPAR) is a certification program offered by the National Association of Healthcare Revenue Integrity (NAHRI). It is designed to provide healthcare professionals with the knowledge and skills necessary to effectively manage patient accounts in a healthcare setting.

The CPAR program consists of two components: an online course and an exam. The online course covers topics such as medical coding, billing, collections, compliance, and customer service. It takes approximately 8-10 hours to complete the course. Upon successful completion of the course, candidates must pass an exam to earn their certification.

The cost for the CPAR program varies depending on whether you are a NAHRI member or non-member. For members, it costs $395 for the online course and $195 for the exam; for non-members, it costs $495 for the online course and $295 for the exam.

To get certified as a CPAR, you must first register with NAHRI and then complete both the online course and exam within one year of registering. After passing both components, you will be awarded your Certified Patient Account Representative (CPAR) certificate from NAHRI.

7. Registered Health Information Technician (RHIT)

A Registered Health Information Technician (RHIT) is a professional who specializes in medical coding and health information management. RHITs are responsible for collecting, organizing, analyzing, and maintaining patient health information. They use various classification systems to code and categorize patient data for insurance reimbursement purposes, for databases and registries, and to maintain patients’ medical and treatment histories.

In order to become an RHIT, you must first complete an accredited associate degree program in health information technology or a related field such as medical coding or health informatics. Most programs take two years to complete, although some may take longer depending on the institution offering the program. Upon completion of the program, students must pass the Registered Health Information Technician (RHIT) exam administered by the American Health Information Management Association (AHIMA).

The cost of the RHIT exam varies depending on whether you are a member of AHIMA or not. For non-members it costs $299 USD; for members it costs $199 USD.

8. American Academy of Professional Coders (AAPC) Certification

The American Academy of Professional Coders (AAPC) is a national professional organization that provides certification and training to individuals in the medical coding field. It is the largest medical coding certification body in the world, with more than 200,000 members.

AAPC certifications are designed to recognize individuals who have achieved a high level of proficiency in medical coding and billing. The certifications demonstrate an individual’s commitment to excellence and knowledge in the field. There are several different types of AAPC certifications available, including Certified Professional Coder (CPC), Certified Professional Coder-Payer (CPC-P), Certified Outpatient Coding Specialist (COCS), Certified Inpatient Coder (CIC), and Certified Professional Medical Auditor (CPMA).

It typically takes between six months and one year to complete the requirements for AAPC certification. This includes completing a course or courses related to medical coding, passing an exam, and meeting any other requirements that may be specific to the type of certification being sought.

To get an AAPC certification, you must first become a member of AAPC. You can do this by registering on their website or by calling their customer service line. Once you have become a member, you can then register for any courses or exams required for your desired certification. After completing all necessary requirements, you will need to submit your application for certification along with payment for the applicable fees.

The cost of AAPC certifications varies depending on which type of certification you are seeking and whether or not you are already an AAPC member. Generally speaking, it costs between $300-$500 USD per exam plus any applicable membership fees.

9. National Association of Healthcare Access Management (NAHAM) Certification

The National Association of Healthcare Access Management (NAHAM) is a professional organization that provides certification for healthcare access professionals. NAHAM certification recognizes the knowledge and expertise of individuals who work in patient access services, such as registration, insurance verification, scheduling, financial counseling, and customer service.

NAHAM offers two levels of certification: Certified Healthcare Access Associate (CHAA) and Certified Healthcare Access Manager (CHAM). The CHAA certification is designed for entry-level patient access staff while the CHAM is designed for experienced professionals in supervisory or management roles.

It typically takes between four to six months to complete the process of becoming certified. To become certified, applicants must successfully pass an exam administered by NAHAM. The exam consists of multiple choice questions related to healthcare access management topics such as patient rights and responsibilities, customer service principles, coding and billing procedures, medical terminology, and more.

The cost to take the exam varies depending on whether you are a member or non-member of NAHAM. For members, the cost is $195 for either level of certification. For non-members, it is $245 for either level of certification. In addition to taking the exam, applicants must also submit a completed application form with proof of education and experience in healthcare access services.

10. American Health Information Management Association (AHIMA) Certification

The American Health Information Management Association (AHIMA) is a professional organization that provides certification for health information professionals. AHIMA certification is designed to recognize individuals who have demonstrated knowledge and competency in the field of health information management. This certification is highly sought after by employers, as it validates an individual’s expertise in the field.

In order to obtain AHIMA certification, individuals must pass a rigorous exam that covers topics such as medical coding, health data analysis, healthcare reimbursement systems, and more. The exam typically takes between three and four hours to complete and can be taken at an authorized testing center or online.

The cost of taking the exam varies depending on which type of certification you are seeking. Generally speaking, exams range from $200-$400 USD. In addition to the cost of the exam, there may also be additional fees associated with obtaining your certification such as application fees or renewal fees.

Once you have passed the exam and obtained your AHIMA certification, it will remain valid for two years before needing to be renewed. Renewal requires that you complete continuing education credits in order to maintain your status as a certified professional.

11. National Council for Prescription Drug Programs (NCPDP) Certification

The National Council for Prescription Drug Programs (NCPDP) is a non-profit organization that works to improve the quality of healthcare through standards development, education, and advocacy. NCPDP Certification is an industry-recognized credential that demonstrates a professional’s knowledge and understanding of the NCPDP standards and their ability to apply them in a real-world setting.

The certification process typically takes between 4-6 weeks from start to finish. To get certified, applicants must first complete an online application form and submit it along with any required documents. Once the application has been approved, applicants will need to take a proctored exam at an authorized testing center. The exam consists of multiple choice questions about NCPDP standards and best practices.

The cost of getting certified varies depending on where you take the exam. Typically, the fee for taking the exam is around $200 USD plus any applicable taxes or fees.

Do You Really Need a Insurance Verification Specialist Certificate?

The answer to this question depends on the specific job you are looking for and the requirements of that position. Generally speaking, an insurance verification specialist certificate is not required in order to work as an insurance verification specialist. However, if the employer requires a certification or if you wish to advance your career in this field, then obtaining a certification may be beneficial.

A certification in insurance verification can provide you with additional knowledge and skills related to the field, such as understanding insurance policies, medical terminology, and coding systems. Additionally, many employers prefer to hire individuals who have certifications because they view them as more reliable and knowledgeable. By having a certification, you will also have completed courses designed specifically for insurance verification specialists which can give you an edge over other applicants who do not have one.

In conclusion, whether or not you need an insurance verification specialist certificate depends on your individual situation and goals. If you are seeking a job that requires it or want to further your career in this field, then obtaining a certification may be beneficial for you.

Related: Insurance Verification Specialist Resume Examples

FAQs About Insurance Verification Specialist Certifications

1. What is an Insurance Verification Specialist Certification?

Answer: An Insurance Verification Specialist Certification is a type of certification and training program that teaches individuals the skills needed to work in the insurance industry, including verifying and processing insurance claims, policy information, and other related tasks.

2. Who should pursue an Insurance Verification Specialist Certification?

Answer: Individuals who are interested in working in the insurance industry or have experience in customer service and administrative roles can benefit from pursuing an Insurance Verification Specialist Certification.

3. What are the requirements to obtain an Insurance Verification Specialist Certification?

Answer: Requirements vary depending on the certifying organization but typically require applicants to pass an exam or complete a certain number of hours of approved coursework.

4. How long does it take to become certified as an Insurance Verification Specialist?

Answer: The amount of time it takes to become certified as an Insurance Verification Specialist depends on the certifying organization and how much time you are able to dedicate to studying for the exam or completing coursework. Generally, it can take anywhere from two months up to a year or more depending on your individual circumstances and needs.

5. Is there any continuing education required for maintain my Insurance Verification Specialist Certification?

Answer: Yes, most certifying organizations require that individuals renew their certification every few years by taking continuing education courses or passing additional exams.