Patient care specialist vs prior authorization specialist

The differences between patient care specialists 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 patient care specialist and a prior authorization specialist. Additionally, a prior authorization specialist has an average salary of $36,120, which is higher than the $34,157 average annual salary of a patient care specialist.

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

Patient care specialist vs prior authorization specialist overview

	Patient Care Specialist	Prior Authorization Specialist
Yearly salary	$34,157	$36,120
Hourly rate	$16.42	$17.37
Growth rate	-4%	-4%
Number of jobs	146,861	69,667
Job satisfaction	-	5
Most common degree	Bachelor's Degree, 40%	Bachelor's Degree, 32%
Average age	40	40
Years of experience	4	4

What does a patient care specialist do?

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.

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.

Patient care specialist vs prior authorization specialist salary

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

	Patient Care Specialist	Prior Authorization Specialist
Average salary	$34,157	$36,120
Salary range	Between $20,000 And $55,000	Between $27,000 And $46,000
Highest paying City	Boston, MA	Framingham, MA
Highest paying state	Massachusetts	Massachusetts
Best paying company	KPG	Washington State University
Best paying industry	Health Care	Health Care

Differences between patient care specialist and prior authorization specialist education

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

	Patient Care Specialist	Prior Authorization Specialist
Most common degree	Bachelor's Degree, 40%	Bachelor's Degree, 32%
Most common major	Business	Nursing
Most common college	University of Pennsylvania	University of Southern California

Patient care specialist vs prior authorization specialist demographics

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

	Patient Care Specialist	Prior Authorization Specialist
Average age	40	40
Gender ratio	Male, 20.3% Female, 79.7%	Male, 18.4% Female, 81.6%
Race ratio	Black or African American, 11.7% Unknown, 5.2% Hispanic or Latino, 21.1% Asian, 6.3% White, 55.0% 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 patient care specialist and prior authorization specialist duties and responsibilities

Patient care specialist example responsibilities.

Use EMR software to manage patient records and files; reinforce and uphold patient confidentiality as required by HIPAA and clinic.
Utilize software applications to document call interactions using medical terminology and responsible for initially engaging patients by explaining the services.
Verify CPT codes along with diagnosis code for guarantee payment for surgeries.
Process daily fee tickets and correctly enter office visit ICD 9 and CPT codes into the system for billing.
Adhere to HIPPA confidentiality guidelines.
Track Medicaid eligibility of clients.

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.

Patient care specialist vs prior authorization specialist skills

Common patient care specialist skills

Patients, 33%
Patient Care, 17%
Data Entry, 5%
Medical Terminology, 4%
CPT, 2%
CPR, 2%

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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Patient Care Specialist
Patient Care Specialist vs Prior Authorization Specialist

Updated January 8, 2025

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