What does a biller 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.

While similarities exist, there are also some differences between billers and prior authorization specialist. For instance, biller responsibilities require skills such as "patient accounts," "medical billing," "math," and "billing process." Whereas a prior authorization specialist is skilled in "medical necessity," "clinical judgment," "medical terminology," and "clinical resource." This is part of what separates the two careers.

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.

While some skills are similar in these professions, other skills aren't so similar. For example, resumes show us that biller responsibilities requires skills like "medical billing," "math," "billing process," and "dmv." But an authorization specialist might use other skills in their typical duties, such as, "medical terminology," "veterans," "medical necessity," and "clinical data."

A patient service or care specialist works at different medical facilities. Primary responsibilities include checking patients in and out, scheduling follow-up appointments as well as checking patient eligibility for services or programs. Patient service specialists should maintain a systematic referral log to correlate patient referrals to other specialists. Applicants for the job should have the basic computer knowledge to effectively manage data of patient's files, knowledge of medical terminologies, and possess good interpersonal and customer service skills.

There are many key differences between these two careers, including some of the skills required to perform responsibilities within each role. For example, a biller is likely to be skilled in "math," "appeals," "icd-10," and "billing process," while a typical patient care specialist is skilled in "patient care," "medical terminology," "cpr," and "phone calls."

A registration specialist is responsible for managing patient information, including the verification of their insurance details and medical treatment schedules. Registration specialists assign admission rooms and processing payments for discharge. They also assist patients with the completion of medical forms by helping them fill-out papers with the most accurate information. A registration specialist performs administrative and clerical duties as needed, requiring them to have excellent data management skills to process information and provide the highest quality care services for the patients.

Even though a few skill sets overlap between billers and registration specialists, there are some differences that are important to note. For one, a biller might have more use for skills like "medical billing," "math," "appeals," and "icd-10." Meanwhile, some responsibilities of registration specialists require skills like "medical terminology," "patient registration," "patient care," and "phone calls. "