What does a prior authorization representative do?

Patient services coordinators act as a liaison between a healthcare organization and patients. Their primary job is to provide quality service to patients. Their duties and responsibilities include fielding telephone calls from patients, assessing patients' issues, and interacting with team members, medical personnel, and employees from other departments. Also, they are responsible for ensuring compliance with regulatory and hospital requirements and maintaining quality service. Patient services coordinators must also ensure to maintain their technical knowledge by participating in personal networks, attending educational workshops, and reviewing professional publications.

There are some key differences in the responsibilities of each position. For example, prior authorization representative responsibilities require skills like "outbound calls," "clinical criteria," "inbound telephone," and "authorization request." Meanwhile a typical patient service coordinator has skills in areas such as "patient care," "front desk," "patient flow," and "check-in." This difference in skills reveals the differences in what each career does.

A patient service representative serves as a patient's primary point of contact in a hospital or clinic, ensuring accuracy and customer satisfaction. They are mainly responsible for gathering a patient's information and medical history, verifying insurance forms, managing accounts, and processing payments, arranging appointments, and even performing reminder calls and correspondence. There are also instances when a patient service representative must discuss situations to patients and their families, and even alert the doctors when a patient displays strange or unlikely behavior.

While some skills are similar in these professions, other skills aren't so similar. For example, resumes show us that prior authorization representative responsibilities requires skills like "customer service," "outbound calls," "excellent organizational," and "clinical criteria." But a patient service specialist might use other skills in their typical duties, such as, "patient service," "physical therapy," "rehabilitation," and "patient appointments."

A patient care coordinator or care coordinator is a trained health professional who manages patients' health care, such as the elderly or disabled. Patient care coordinators educate patients about their health conditions and develop a plan to address their personal health care needs. To comply with health care laws and regulations, care coordinators must attend training and courses so that they are updated with the new developments in health care. They are also required to take up licensure examination and should have experience in care coordination or clinical practices.

The required skills of the two careers differ considerably. For example, prior authorization representatives are more likely to have skills like "medical terminology," "clinical criteria," "inbound telephone," and "authorization request." But a patient care coordinator is more likely to have skills like "home health," "patient appointments," "direct patient care," and "phone calls."

A patient service associate is responsible for providing high-quality care services to the patients, ensuring their satisfaction by assisting their medical needs and concerns. Patient service associates perform administrative duties, such as helping patients to fill-out forms, updating patients' information on the database, processing payments for medical procedures, storing patients' medical files, and monitoring the adequacy of medical tools and supplies. They may also conduct basic medical operations under the supervision of a physician or a health professional, adhering to strict protocols and regulations at all times to avoid hazards and health risks.

Even though a few skill sets overlap between prior authorization representatives and patient service associates, there are some differences that are important to note. For one, a prior authorization representative might have more use for skills like "clinical criteria," "inbound telephone," "authorization request," and "insurance benefits." Meanwhile, some responsibilities of patient service associates require skills like "patient care," "patient service," "patient calls," and "allergies. "