Prior authorization specialist vs authorization specialist

The differences between prior authorization specialists 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 specialist and an authorization specialist. Additionally, an authorization specialist has an average salary of $36,518, which is higher than the $36,120 average annual salary of a prior authorization specialist.

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

Prior authorization specialist vs authorization specialist overview

	Prior Authorization Specialist	Authorization Specialist
Yearly salary	$36,120	$36,518
Hourly rate	$17.37	$17.56
Growth rate	-4%	-4%
Number of jobs	69,667	71,831
Job satisfaction	5	-
Most common degree	Bachelor's Degree, 32%	Bachelor's Degree, 33%
Average age	40	40
Years of experience	4	4

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.

What does an authorization specialist do?

An authorization specialist is responsible for reviewing insurance claims and determining the necessary settlement for the clients and involved parties. Authorization specialists file documents and gather the required information for further investigation and analysis. They coordinate with the insurance agency and the medical institution and ensure that the correct communications are being sent out for reference. An authorization specialist must have excellent communication and organizational skills, especially in writing authorization requests and resolve claims timely and efficiently.

Prior authorization specialist vs authorization specialist salary

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

	Prior Authorization Specialist	Authorization Specialist
Average salary	$36,120	$36,518
Salary range	Between $27,000 And $46,000	Between $28,000 And $47,000
Highest paying City	Framingham, MA	Milford, MA
Highest paying state	Massachusetts	Massachusetts
Best paying company	Washington State University	Guidehouse
Best paying industry	Health Care	Health Care

Differences between prior authorization specialist and authorization specialist education

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

	Prior Authorization Specialist	Authorization Specialist
Most common degree	Bachelor's Degree, 32%	Bachelor's Degree, 33%
Most common major	Nursing	Business
Most common college	University of Southern California	University of Pennsylvania

Prior authorization specialist vs authorization specialist demographics

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

	Prior Authorization Specialist	Authorization Specialist
Average age	40	40
Gender ratio	Male, 18.4% Female, 81.6%	Male, 15.4% Female, 84.6%
Race ratio	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%	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 specialist and authorization specialist duties and responsibilities

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.

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 specialist vs authorization specialist skills

Common prior authorization specialist skills

Patients, 18%
Customer Service, 8%
Medical Necessity, 8%
Medical Terminology, 6%
Clinical Resource, 6%
Authorization Process, 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 Specialist
Prior Authorization Specialist vs Authorization Specialist

Updated January 8, 2025

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