Prior authorization specialist vs insurance coordinator

The differences between prior authorization specialists and insurance coordinators 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 insurance coordinator. Additionally, a prior authorization specialist has an average salary of $36,120, which is higher than the $32,788 average annual salary of an insurance coordinator.

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

Prior authorization specialist vs insurance coordinator overview

	Prior Authorization Specialist	Insurance Coordinator
Yearly salary	$36,120	$32,788
Hourly rate	$17.37	$15.76
Growth rate	-4%	-3%
Number of jobs	69,667	108,509
Job satisfaction	5	-
Most common degree	Bachelor's Degree, 32%	Bachelor's Degree, 36%
Average age	40	44
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 insurance coordinator do?

An insurance coordinator is responsible for evaluating and validating insurance information to verify claims and process the necessary claims resolutions for parties. Insurance coordinators submit claims statements timely to the insurance officers for review, coordinate with the clients for inquiries and updates, and reach out to medical institutions for accurate filing of payments. An insurance coordinator must have excellent communication and analytical skills to assess reports, resolve claims discrepancies, and escalate high-level complaints to the officers for immediate action.

Prior authorization specialist vs insurance coordinator salary

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

	Prior Authorization Specialist	Insurance Coordinator
Average salary	$36,120	$32,788
Salary range	Between $27,000 And $46,000	Between $25,000 And $41,000
Highest paying City	Framingham, MA	Oakland, CA
Highest paying state	Massachusetts	New Hampshire
Best paying company	Washington State University	University of California, Berkeley
Best paying industry	Health Care	Pharmaceutical

Differences between prior authorization specialist and insurance coordinator education

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

	Prior Authorization Specialist	Insurance Coordinator
Most common degree	Bachelor's Degree, 32%	Bachelor's Degree, 36%
Most common major	Nursing	Business
Most common college	University of Southern California	-

Prior authorization specialist vs insurance coordinator demographics

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

	Prior Authorization Specialist	Insurance Coordinator
Average age	40	44
Gender ratio	Male, 18.4% Female, 81.6%	Male, 9.9% Female, 90.1%
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, 13.8% Unknown, 4.3% Hispanic or Latino, 14.4% Asian, 3.9% White, 63.2% American Indian and Alaska Native, 0.5%
LGBT Percentage	7%	11%

Differences between prior authorization specialist and insurance coordinator 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.

Insurance coordinator example responsibilities.

Verify patient dental insurance coverage and limitations with major private and business dental insurance providers as well as Medicaid and Medicare.
File to record patient demographics in numerous EMR systems and paper charts if applicable.
Prepare providers and staff for ICD-10 transition.
Post and reconcile all daily insurance, patient payments and transactions within the EMR system.
Experience in registration in healthcare, business office and physician billing, with reimbursement and collections.
Process all Medicare claims, explaining HMO changes to patients in detail and accurately documenting all benefits.

Prior authorization specialist vs insurance coordinator skills

Common prior authorization specialist skills

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

Common insurance coordinator skills

Patients, 26%
Customer Service, 11%
Insurance Verification, 7%
Insurance Eligibility, 4%
Medicaid, 3%
Medical Terminology, 3%

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Prior Authorization Specialist
Prior Authorization Specialist vs Insurance Coordinator

Updated January 8, 2025

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