Prior authorization specialist vs billing specialist

The differences between prior authorization specialists and billing specialists 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 specialist takes usually requires 1-2 years. Additionally, a prior authorization specialist has an average salary of $36,120, which is higher than the $35,624 average annual salary of a billing specialist.

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

Prior authorization specialist vs billing specialist overview

	Prior Authorization Specialist	Billing Specialist
Yearly salary	$36,120	$35,624
Hourly rate	$17.37	$17.13
Growth rate	-4%	-3%
Number of jobs	69,667	55,205
Job satisfaction	5	-
Most common degree	Bachelor's Degree, 32%	Bachelor's Degree, 31%
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 specialist do?

Billing specialists are accounting or finance employees who are responsible for sending out billing invoices to clients. They calculate charges that their clients have incurred. They then write bills, ensure that all details are correct, and send these out to clients. They also manage payment due dates and ensure that clients are duly reminded of such deadlines. Billing specialists also manage client accounts and ensure that they are paying on time. They help identify clients who have outstanding payables and send out collection notices to them. At times, billing specialists also manage the receipt of payments to manage account records better.

Prior authorization specialist vs billing specialist salary

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

	Prior Authorization Specialist	Billing Specialist
Average salary	$36,120	$35,624
Salary range	Between $27,000 And $46,000	Between $27,000 And $45,000
Highest paying City	Framingham, MA	Washington, DC
Highest paying state	Massachusetts	Delaware
Best paying company	Washington State University	TIBCO Software
Best paying industry	Health Care	Manufacturing

Differences between prior authorization specialist and billing specialist education

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

	Prior Authorization Specialist	Billing Specialist
Most common degree	Bachelor's Degree, 32%	Bachelor's Degree, 31%
Most common major	Nursing	Business
Most common college	University of Southern California	University of Pennsylvania

Prior authorization specialist vs billing specialist demographics

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

	Prior Authorization Specialist	Billing Specialist
Average age	40	46
Gender ratio	Male, 18.4% Female, 81.6%	Male, 12.7% Female, 87.3%
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, 10.9% Unknown, 4.4% Hispanic or Latino, 19.2% Asian, 7.4% White, 57.3% American Indian and Alaska Native, 0.9%
LGBT Percentage	7%	7%

Differences between prior authorization specialist and billing 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.

Billing specialist example responsibilities.

Use of QuickBooks to manage vendors' accounts, set up filing system to maintain files and supporting billing documents.
Manage the daily correspondence with keeping doctor/patient confidentiality under consideration along with HIPPA regulations.
Use independent judgment, manage and impart confidential information appropriately per HIPAA regulations and company requirements.
Accept and process healthcare claims and confidential medical records; verify patient eligibility and manage the Medicare and Medicaid billing process.
Provide additional information/clarification for insurance claims using knowledge of CPT, ICD-9, and HCPCS codes, as well as modifiers.
Assist staff with proper billing for patients, ensure proper coding using ICD-10, ICD-9 and CPT-4 coding.

Prior authorization specialist vs billing 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 billing specialist skills

Patients, 16%
Customer Service, 10%
Data Entry, 9%
Medical Billing, 7%
Medicaid, 6%
CPT, 3%

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Prior Authorization Specialist
Prior Authorization Specialist vs Billing Specialist

Updated January 8, 2025

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