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Medicare correspondence representative vs prior authorization specialist

The differences between medicare correspondence 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 a medicare correspondence representative and a prior authorization specialist. Additionally, a medicare correspondence representative has an average salary of $37,896, which is higher than the $36,120 average annual salary of a prior authorization specialist.

The top three skills for a medicare correspondence representative include patients, appeals and customer issues. The most important skills for a prior authorization specialist are patients, customer service, and medical necessity.

Medicare correspondence representative vs prior authorization specialist overview

Medicare Correspondence RepresentativePrior Authorization Specialist
Yearly salary$37,896$36,120
Hourly rate$18.22$17.37
Growth rate-4%-4%
Number of jobs28,55469,667
Job satisfaction-5
Most common degreeBachelor's Degree, 35%Bachelor's Degree, 32%
Average age4040
Years of experience44

Medicare correspondence representative vs prior authorization specialist salary

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

Medicare Correspondence RepresentativePrior Authorization Specialist
Average salary$37,896$36,120
Salary rangeBetween $29,000 And $49,000Between $27,000 And $46,000
Highest paying City-Framingham, MA
Highest paying state-Massachusetts
Best paying company-Washington State University
Best paying industry-Health Care

Differences between medicare correspondence representative and prior authorization specialist education

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

Medicare Correspondence RepresentativePrior Authorization Specialist
Most common degreeBachelor's Degree, 35%Bachelor's Degree, 32%
Most common majorBusinessNursing
Most common collegeStanford UniversityUniversity of Southern California

Medicare correspondence representative vs prior authorization specialist demographics

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

Medicare Correspondence RepresentativePrior Authorization Specialist
Average age4040
Gender ratioMale, 24.6% Female, 75.4%Male, 18.4% Female, 81.6%
Race ratioBlack or African American, 10.4% Unknown, 4.9% Hispanic or Latino, 21.2% Asian, 6.2% White, 56.6% American Indian and Alaska Native, 0.6%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 Percentage7%7%

Differences between medicare correspondence representative and prior authorization specialist duties and responsibilities

Medicare correspondence representative example responsibilities.

  • Manage CMS communications throughout the organization.
  • Follow specific HIPAA guidelines as set forth by company regulations.
  • Maintain, update, and review member files adhering to strict HIPPA guidelines.
  • Send high volume of written correspondence/affirmation letters to providers and patients.
  • Provide professional and confidentiality with patient information due to HIPPA regulations.
  • Assist with data reports by comparing enrollment error reports against system information along with CMS records to validate information accuracy.
    • Show more

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.
    • Show more

Medicare correspondence representative vs prior authorization specialist skills

Common medicare correspondence representative skills
  • Patients, 18%
  • Appeals, 9%
  • Customer Issues, 8%
  • CMS, 7%
  • Medicaid, 6%
  • Inbound Calls, 6%
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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Updated January 8, 2025

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