Authorized representative vs prior authorization specialist

The differences between authorized representatives and prior authorization specialists can be seen in a few details. Each job has different responsibilities and duties. It typically takes 2-4 years to become both an authorized representative and a prior authorization specialist. Additionally, an authorized representative has an average salary of $38,897, which is higher than the $36,120 average annual salary of a prior authorization specialist.

The top three skills for an authorized representative include patients, medical terminology and insurance verification. The most important skills for a prior authorization specialist are patients, customer service, and medical necessity.

Authorized representative vs prior authorization specialist overview

	Authorized Representative	Prior Authorization Specialist
Yearly salary	$38,897	$36,120
Hourly rate	$18.70	$17.37
Growth rate	-4%	-4%
Number of jobs	64,806	69,667
Job satisfaction	-	5
Most common degree	Bachelor's Degree, 39%	Bachelor's Degree, 32%
Average age	40	40
Years of experience	4	4

What does an authorized representative do?

An authorized representative's primary role is to represent an individual or company in different official transactions. They have the authority to communicate, liaise, negotiate, and make decisions according to goals and project requirements. Although most authorized representatives have varying responsibilities depending on their company of employment, it usually includes understanding project needs, liaising with internal and external parties, preparing and processing documents, organizing files, handling calls and correspondence, and monitoring the transactions' progress. Moreover, as an authorized representative, it is essential to be proactive at dealing with issues, resolving them promptly and professionally.

What does a prior authorization specialist do?

Prior Authorization Specialists are individuals responsible for the entire process of prior authorization for a client. They manage communication between stakeholders of clients, healthcare providers, and insurance companies to request for prior authorizations. Their duties include ensuring complete and updated patient and claim documentation, performing daily billings, auditing accounts for accurate submissions claim, and making sure patient treatment reimbursements are processed effectively. Prior Authorization Specialists also review outstanding accounts and handle reimbursement or billing issues to ensure clean billing claims.

Authorized representative vs prior authorization specialist salary

Authorized representatives and prior authorization specialists have different pay scales, as shown below.

	Authorized Representative	Prior Authorization Specialist
Average salary	$38,897	$36,120
Salary range	Between $29,000 And $50,000	Between $27,000 And $46,000
Highest paying City	Elmira, NY	Framingham, MA
Highest paying state	New York	Massachusetts
Best paying company	Hill International	Washington State University
Best paying industry	Insurance	Health Care

Differences between authorized representative and prior authorization specialist education

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

	Authorized Representative	Prior Authorization Specialist
Most common degree	Bachelor's Degree, 39%	Bachelor's Degree, 32%
Most common major	Business	Nursing
Most common college	Stanford University	University of Southern California

Authorized representative vs prior authorization specialist demographics

Here are the differences between authorized representatives' and prior authorization specialists' demographics:

	Authorized Representative	Prior Authorization Specialist
Average age	40	40
Gender ratio	Male, 29.6% Female, 70.4%	Male, 18.4% Female, 81.6%
Race ratio	Black or African American, 10.5% Unknown, 5.4% Hispanic or Latino, 23.3% Asian, 6.6% White, 53.4% American Indian and Alaska Native, 0.7%	Black or African American, 9.2% Unknown, 5.3% Hispanic or Latino, 23.0% Asian, 6.9% White, 54.9% American Indian and Alaska Native, 0.7%
LGBT Percentage	7%	7%

Differences between authorized representative and prior authorization specialist duties and responsibilities

Authorized representative example responsibilities.

Coach, evaluate and performance manage MSRs to ensure timely and accurate service to clients.
Audit requests to ensure that proper ICD-9 and CPT coding are applied.
Research coordinator and referral coordinator, obtain insurance authorization and provide information to insurance carriers or patients regarding patient accounts.
Verify (CCS), CHDP, HMO, PPO authorizations.
Adhere strictly to HIPAA privacy guidelines.
Scan Medicaid coverage in to patient's electronic file.

Prior authorization specialist example responsibilities.

Utilize CMS and InterQual criteria to establish authorizations for members requiring medical services for a Medicare advantage insurance company.
Manage quality communication, patient support and service representation with patients and providers to establish equipment/procedures statuses and expedite orders.
Work with staff to ensure proper CPT codes are submit on authorization request.
Demonstrate compassion while obtaining patient demographics and personal health information.
Register patients into the emergency department or outpatients for surgery or procedures.
Register patients' demographics and insurance information; execute daily outpatient and surgery reports.

Authorized representative vs prior authorization specialist skills

Common authorized representative skills

Patients, 24%
Medical Terminology, 11%
Insurance Verification, 7%
CPT, 5%
Insurance Authorizations, 5%
Data Entry, 4%

Common prior authorization specialist skills

Patients, 18%
Customer Service, 8%
Medical Necessity, 8%
Medical Terminology, 6%
Clinical Resource, 6%
Authorization Process, 4%

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Authorized Representative
Authorized Representative vs Prior Authorization Specialist

Updated January 8, 2025

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