Prior authorization specialist vs billing representative

The differences between prior authorization specialists and billing representatives can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 2-4 years to become a prior authorization specialist, becoming a billing representative takes usually requires 1-2 years. Additionally, a prior authorization specialist has an average salary of $36,120, which is higher than the $35,002 average annual salary of a billing representative.

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

Prior authorization specialist vs billing representative overview

	Prior Authorization Specialist	Billing Representative
Yearly salary	$36,120	$35,002
Hourly rate	$17.37	$16.83
Growth rate	-4%	-3%
Number of jobs	69,667	95,425
Job satisfaction	5	-
Most common degree	Bachelor's Degree, 32%	Bachelor's Degree, 30%
Average age	40	46
Years of experience	4	2

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 a billing representative do?

A billing representative assists with the overall operations of the organization's billing department. Billing representatives post payments timely on the database, update account statements, generate financial reports, release invoices, and resolve account discrepancies. They also perform client accounts reconciliation as needed, monitor account receivables, review overdated balance, and notify clients of payment updates to ensure accurate and timely billing. A billing representative must have strong analytical and communication skills to manage clients' accounts, as well as comprehensive knowledge on the accounting industry to explain the payment terms and policies of an organization to a client.

Prior authorization specialist vs billing representative salary

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

	Prior Authorization Specialist	Billing Representative
Average salary	$36,120	$35,002
Salary range	Between $27,000 And $46,000	Between $28,000 And $42,000
Highest paying City	Framingham, MA	Worcester, MA
Highest paying state	Massachusetts	Massachusetts
Best paying company	Washington State University	Relevante
Best paying industry	Health Care	Technology

Differences between prior authorization specialist and billing representative education

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

	Prior Authorization Specialist	Billing Representative
Most common degree	Bachelor's Degree, 32%	Bachelor's Degree, 30%
Most common major	Nursing	Business
Most common college	University of Southern California	Stanford University

Prior authorization specialist vs billing representative demographics

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

	Prior Authorization Specialist	Billing Representative
Average age	40	46
Gender ratio	Male, 18.4% Female, 81.6%	Male, 15.7% Female, 84.3%
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, 10.4% Unknown, 4.3% Hispanic or Latino, 19.9% Asian, 7.3% White, 57.2% American Indian and Alaska Native, 0.9%
LGBT Percentage	7%	7%

Differences between prior authorization specialist and billing representative 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.

Billing representative example responsibilities.

Manage software programs for MSP accounts, monthly billing and EMC file transfers to Medicare.
Accept and process healthcare claims and confidential medical records; verify patient eligibility and manage the Medicare and Medicaid billing process.
Process orders in compliance with Medicare, Medicaid and private insurance verification guidelines; confirming customer's eligibility and insurance coverage.
Verify insurance eligibility for schedule appointments, and verify cash pricing for private pay patients who request cost by CPT code.
Submit and receive Medicare and Medicaid claims electronically on a daily basis.
Utilize extensive computer skills and coding knowledge to produce and submit physical therapy and occupational therapy claims through medicaid and medicare.

Prior authorization specialist vs billing representative skills

Common prior authorization specialist skills

Patients, 18%
Customer Service, 8%
Medical Necessity, 8%
Medical Terminology, 6%
Clinical Resource, 6%
Authorization Process, 4%

Common billing representative skills

Patients, 18%
Customer Service, 13%
Data Entry, 6%
Medical Billing, 5%
Medicaid, 5%
Patient Accounts, 4%

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Prior Authorization Specialist
Prior Authorization Specialist vs Billing Representative

Updated January 8, 2025

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