Prior authorization representative vs authorization specialist

The differences between prior authorization representatives and 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 prior authorization representative and an authorization specialist. Additionally, a prior authorization representative has an average salary of $38,726, which is higher than the $36,518 average annual salary of an authorization specialist.

The top three skills for a prior authorization representative include patients, customer service and outbound calls. The most important skills for an authorization specialist are patients, customer service, and insurance verification.

Prior authorization representative vs authorization specialist overview

	Prior Authorization Representative	Authorization Specialist
Yearly salary	$38,726	$36,518
Hourly rate	$18.62	$17.56
Growth rate	-4%	-4%
Number of jobs	55,498	71,831
Job satisfaction	-	-
Most common degree	High School Diploma, 24%	Bachelor's Degree, 33%
Average age	40	40
Years of experience	4	4

Prior authorization representative vs authorization specialist salary

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

	Prior Authorization Representative	Authorization Specialist
Average salary	$38,726	$36,518
Salary range	Between $29,000 And $51,000	Between $28,000 And $47,000
Highest paying City	Attleboro, MA	Milford, MA
Highest paying state	Massachusetts	Massachusetts
Best paying company	NTT Data International L.L.C.	Guidehouse
Best paying industry	Health Care	Health Care

Differences between prior authorization representative and authorization specialist education

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

	Prior Authorization Representative	Authorization Specialist
Most common degree	High School Diploma, 24%	Bachelor's Degree, 33%
Most common major	Business	Business
Most common college	Howard University	University of Pennsylvania

Prior authorization representative vs authorization specialist demographics

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

	Prior Authorization Representative	Authorization Specialist
Average age	40	40
Gender ratio	Male, 21.1% Female, 78.9%	Male, 15.4% Female, 84.6%
Race ratio	Black or African American, 9.7% Unknown, 5.2% Hispanic or Latino, 18.0% Asian, 5.8% White, 60.6% American Indian and Alaska Native, 0.7%	Black or African American, 10.8% Unknown, 5.5% Hispanic or Latino, 22.6% Asian, 6.9% White, 53.6% American Indian and Alaska Native, 0.8%
LGBT Percentage	7%	7%

Differences between prior authorization representative and authorization specialist duties and responsibilities

Prior authorization representative example responsibilities.

Manage inbound/outbound calls for medical personnel and patients, along with computerize data entry to regulate proper distribution of prescription medication.
Utilize knowledge of physician office policies, CPT and ICD-9 coding, procedures, and equipment.
Provide compassion without judgment in regards to patient's finances.
Determine if CPT and ICD-10 codes are correct and qualify for coverage.
Review all daily EDI reports to make sure claims are being accept properly.
Perform chart audits via EMR, prepare medical records for subpoenas, general requests.

Authorization specialist example responsibilities.

Demonstrate knowledge of HIPAA by appropriately managing patient confidentiality.
Utilize CMS and InterQual criteria to establish authorizations for members requiring medical services for a Medicare advantage insurance company.
Build authorization, match ICD-10 codes with there procedure codes
Provide patients with patient registration forms in order to follow up on patient check-in and check-out utilizing a proprietary management system.
Obtain verification of insurance coverage and authorizations for clinical visits and surgical procedures for patients.
Perform all components of the office registration including arrival, check-in and future appointments.

Prior authorization representative vs authorization specialist skills

Common prior authorization representative skills

Patients, 26%
Customer Service, 8%
Outbound Calls, 5%
Medical Terminology, 4%
Data Entry, 4%
Insurance Coverage, 4%

Common authorization specialist skills

Patients, 20%
Customer Service, 10%
Insurance Verification, 6%
Medical Terminology, 6%
Insurance Eligibility, 4%
Veterans, 4%

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Prior Authorization Representative
Prior Authorization Representative vs Authorization Specialist

Updated January 8, 2025

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