Prior authorization representative vs prior authorization specialist

The differences between prior authorization 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 prior authorization representative and a prior authorization specialist. Additionally, a prior authorization representative has an average salary of $38,726, which is higher than the $36,120 average annual salary of a prior authorization specialist.

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

Prior authorization representative vs prior authorization specialist overview

	Prior Authorization Representative	Prior Authorization Specialist
Yearly salary	$38,726	$36,120
Hourly rate	$18.62	$17.37
Growth rate	-4%	-4%
Number of jobs	55,498	69,667
Job satisfaction	-	5
Most common degree	High School Diploma, 24%	Bachelor's Degree, 32%
Average age	40	40
Years of experience	4	4

Prior authorization representative vs prior authorization specialist salary

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

	Prior Authorization Representative	Prior Authorization Specialist
Average salary	$38,726	$36,120
Salary range	Between $29,000 And $51,000	Between $27,000 And $46,000
Highest paying City	Attleboro, MA	Framingham, MA
Highest paying state	Massachusetts	Massachusetts
Best paying company	NTT Data International L.L.C.	Washington State University
Best paying industry	Health Care	Health Care

Differences between prior authorization representative and prior authorization specialist education

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

	Prior Authorization Representative	Prior Authorization Specialist
Most common degree	High School Diploma, 24%	Bachelor's Degree, 32%
Most common major	Business	Nursing
Most common college	Howard University	University of Southern California

Prior authorization representative vs prior authorization specialist demographics

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

	Prior Authorization Representative	Prior Authorization Specialist
Average age	40	40
Gender ratio	Male, 21.1% Female, 78.9%	Male, 18.4% Female, 81.6%
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, 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 prior authorization representative and prior 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.

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.

Prior authorization representative vs prior 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 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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Prior Authorization Representative
Prior Authorization Representative vs Prior Authorization Specialist

Updated January 8, 2025

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