Biller vs prior authorization specialist

The differences between billers and prior authorization specialists can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 1-2 years to become a biller, becoming a prior authorization specialist takes usually requires 2-4 years. Additionally, a biller has an average salary of $38,333, which is higher than the $36,120 average annual salary of a prior authorization specialist.

The top three skills for a biller include patients, customer service and data entry. The most important skills for a prior authorization specialist are patients, customer service, and medical necessity.

Biller vs prior authorization specialist overview

	Biller	Prior Authorization Specialist
Yearly salary	$38,333	$36,120
Hourly rate	$18.43	$17.37
Growth rate	-3%	-4%
Number of jobs	35,740	69,667
Job satisfaction	-	5
Most common degree	Associate Degree, 28%	Bachelor's Degree, 32%
Average age	46	40
Years of experience	2	4

What does a biller do?

Billers are medical professionals who are responsible for translating health care services into medical claims to be submitted to insurance companies. These billers are required to obtain patient medical records and interpret them to determine the billable units and services. They must manage all aspects of the medical billing process and make necessary contacts with insurance payers or patients to ensure maximum reimbursements. Billers must also provide services that are associated with internal and external customer billing and payment processing operations.

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.

Biller vs prior authorization specialist salary

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

	Biller	Prior Authorization Specialist
Average salary	$38,333	$36,120
Salary range	Between $29,000 And $49,000	Between $27,000 And $46,000
Highest paying City	Washington, DC	Framingham, MA
Highest paying state	Washington	Massachusetts
Best paying company	UC Merced	Washington State University
Best paying industry	Manufacturing	Health Care

Differences between biller and prior authorization specialist education

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

	Biller	Prior Authorization Specialist
Most common degree	Associate Degree, 28%	Bachelor's Degree, 32%
Most common major	Health Care Administration	Nursing
Most common college	Stanford University	University of Southern California

Biller vs prior authorization specialist demographics

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

	Biller	Prior Authorization Specialist
Average age	46	40
Gender ratio	Male, 11.6% Female, 88.4%	Male, 18.4% Female, 81.6%
Race ratio	Black or African American, 9.4% Unknown, 4.3% Hispanic or Latino, 21.8% Asian, 6.8% White, 56.9% American Indian and Alaska Native, 0.8%	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 biller and prior authorization specialist duties and responsibilities

Biller example responsibilities.

Manage payer requirements, regulatory compliance requirements, HIPAA privacy and security requirements, medical terminology and general revenue cycle procedures.
Ensure all ICD-9 and CPT coding are correct and forward any errors to the appropriate departments to correct.
Prepare forms for CPT-4 and ICD-9 coding.
Acquire a working knowledge of revenue codes and HCPCS codes.
Answer phones, review, verifying insurance and ICD-9 coding of service reports.
Maintain confidentiality of all pertinent client information in compliance with HIPAA laws and regulations.

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.

Biller vs prior authorization specialist skills

Common biller skills

Patients, 18%
Customer Service, 10%
Data Entry, 6%
CPT, 5%
Medicaid, 4%
Patient Accounts, 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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Biller vs Prior Authorization Specialist

Updated January 8, 2025

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