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Prior authorization representative vs patient care representative

The differences between prior authorization representatives and patient care representatives 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 a patient care representative. Additionally, a prior authorization representative has an average salary of $38,726, which is higher than the $33,709 average annual salary of a patient care representative.

The top three skills for a prior authorization representative include patients, customer service and outbound calls. The most important skills for a patient care representative are patients, patient care, and home health.

Prior authorization representative vs patient care representative overview

Prior Authorization RepresentativePatient Care Representative
Yearly salary$38,726$33,709
Hourly rate$18.62$16.21
Growth rate-4%-4%
Number of jobs55,498133,317
Job satisfaction--
Most common degreeHigh School Diploma, 24%Bachelor's Degree, 39%
Average age4040
Years of experience44

Prior authorization representative vs patient care representative salary

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

Prior Authorization RepresentativePatient Care Representative
Average salary$38,726$33,709
Salary rangeBetween $29,000 And $51,000Between $27,000 And $41,000
Highest paying CityAttleboro, MABoston, MA
Highest paying stateMassachusettsAlaska
Best paying companyNTT Data International L.L.C.Massachusetts General Hospital
Best paying industryHealth CareTechnology

Differences between prior authorization representative and patient care representative education

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

Prior Authorization RepresentativePatient Care Representative
Most common degreeHigh School Diploma, 24%Bachelor's Degree, 39%
Most common majorBusinessBusiness
Most common collegeHoward UniversityUniversity of Pennsylvania

Prior authorization representative vs patient care representative demographics

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

Prior Authorization RepresentativePatient Care Representative
Average age4040
Gender ratioMale, 21.1% Female, 78.9%Male, 17.1% Female, 82.9%
Race ratioBlack 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, 12.5% Unknown, 5.1% Hispanic or Latino, 20.3% Asian, 6.3% White, 55.2% American Indian and Alaska Native, 0.6%
LGBT Percentage7%7%

Differences between prior authorization representative and patient care representative 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.
    • Show more

Patient care representative example responsibilities.

  • Manage cash and co-payments accurately and discharge patients providing them with proper medical notes and information before exiting.
  • Verify insurance, Medicaid, Medicare, register patients, and code proper ICD-9 and CPT codes on encounters.
  • Utilize medical terminology, CPT, HCPC and ICD-9 and patient information into new authorizations.
  • Interview patients to gather information pertinent to their Medicaid application.
  • Screen, identify, and enter ICD-9 coding from treatment record forms.
  • Maintain patient confidentiality and follow HIPAA rules.
    • Show more

Prior authorization representative vs patient care representative skills

Common prior authorization representative skills
  • Patients, 26%
  • Customer Service, 8%
  • Outbound Calls, 5%
  • Medical Terminology, 4%
  • Data Entry, 4%
  • Insurance Coverage, 4%
Common patient care representative skills
  • Patients, 25%
  • Patient Care, 13%
  • Home Health, 7%
  • Cash Management, 5%
  • Phone Calls, 4%
  • CPT, 3%

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Updated January 8, 2025

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