Authorization specialist vs patient care representative

The differences between authorization specialists and patient care representatives can be seen in a few details. Each job has different responsibilities and duties. It typically takes 2-4 years to become both an authorization specialist and a patient care representative. Additionally, an authorization specialist has an average salary of $36,518, which is higher than the $33,709 average annual salary of a patient care representative.

The top three skills for an authorization specialist include patients, customer service and insurance verification. The most important skills for a patient care representative are patients, patient care, and home health.

Authorization specialist vs patient care representative overview

	Authorization Specialist	Patient Care Representative
Yearly salary	$36,518	$33,709
Hourly rate	$17.56	$16.21
Growth rate	-4%	-4%
Number of jobs	71,831	133,317
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 33%	Bachelor's Degree, 39%
Average age	40	40
Years of experience	4	4

What does an authorization specialist do?

An authorization specialist is responsible for reviewing insurance claims and determining the necessary settlement for the clients and involved parties. Authorization specialists file documents and gather the required information for further investigation and analysis. They coordinate with the insurance agency and the medical institution and ensure that the correct communications are being sent out for reference. An authorization specialist must have excellent communication and organizational skills, especially in writing authorization requests and resolve claims timely and efficiently.

What does a patient care representative do?

PCRs (Patient Care Representatives) are given responsibilities like updating and verifying patient information after every visit, scheduling and reminding patients about appointments, and informing patients about delays and how long the estimated waiting times will be. They are also responsible for obtaining patients' personal information like their address, contact details, insurance information, and medical and surgical history. They must be able to communicate with patients, family members, and medical staff to give them all the information they need to treat the person looking for medical help.

Authorization specialist vs patient care representative salary

Authorization specialists and patient care representatives have different pay scales, as shown below.

	Authorization Specialist	Patient Care Representative
Average salary	$36,518	$33,709
Salary range	Between $28,000 And $47,000	Between $27,000 And $41,000
Highest paying City	Milford, MA	Boston, MA
Highest paying state	Massachusetts	Alaska
Best paying company	Guidehouse	Massachusetts General Hospital
Best paying industry	Health Care	Technology

Differences between authorization specialist and patient care representative education

There are a few differences between an authorization specialist and a patient care representative in terms of educational background:

	Authorization Specialist	Patient Care Representative
Most common degree	Bachelor's Degree, 33%	Bachelor's Degree, 39%
Most common major	Business	Business
Most common college	University of Pennsylvania	University of Pennsylvania

Authorization specialist vs patient care representative demographics

Here are the differences between authorization specialists' and patient care representatives' demographics:

	Authorization Specialist	Patient Care Representative
Average age	40	40
Gender ratio	Male, 15.4% Female, 84.6%	Male, 17.1% Female, 82.9%
Race ratio	Black or African American, 10.8% Unknown, 5.5% Hispanic or Latino, 22.6% Asian, 6.9% White, 53.6% American Indian and Alaska Native, 0.8%	Black or African American, 12.5% Unknown, 5.1% Hispanic or Latino, 20.3% Asian, 6.3% White, 55.2% American Indian and Alaska Native, 0.6%
LGBT Percentage	7%	7%

Differences between authorization specialist and patient care representative duties and responsibilities

Authorization specialist example responsibilities.

Demonstrate knowledge of HIPAA by appropriately managing patient confidentiality.
Utilize CMS and InterQual criteria to establish authorizations for members requiring medical services for a Medicare advantage insurance company.
Build authorization, match ICD-10 codes with there procedure codes
Provide patients with patient registration forms in order to follow up on patient check-in and check-out utilizing a proprietary management system.
Obtain verification of insurance coverage and authorizations for clinical visits and surgical procedures for patients.
Perform all components of the office registration including arrival, check-in and future appointments.

Patient care representative example responsibilities.

Manage cash and co-payments accurately and discharge patients providing them with proper medical notes and information before exiting.
Verify insurance, Medicaid, Medicare, register patients, and code proper ICD-9 and CPT codes on encounters.
Utilize medical terminology, CPT, HCPC and ICD-9 and patient information into new authorizations.
Interview patients to gather information pertinent to their Medicaid application.
Screen, identify, and enter ICD-9 coding from treatment record forms.
Maintain patient confidentiality and follow HIPAA rules.

Authorization specialist vs patient care representative skills

Common authorization specialist skills

Patients, 20%
Customer Service, 10%
Insurance Verification, 6%
Medical Terminology, 6%
Insurance Eligibility, 4%
Veterans, 4%

Common patient care representative skills

Patients, 25%
Patient Care, 13%
Home Health, 7%
Cash Management, 5%
Phone Calls, 4%
CPT, 3%

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Authorization Specialist
Authorization Specialist vs Patient Care Representative

Updated January 8, 2025

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