Prior authorization specialist vs insurance verification specialist

The differences between prior authorization specialists and insurance verification specialists can be seen in a few details. Each job has different responsibilities and duties. Additionally, a prior authorization specialist has an average salary of $36,120, which is higher than the $33,043 average annual salary of an insurance verification specialist.

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

Prior authorization specialist vs insurance verification specialist overview

	Prior Authorization Specialist	Insurance Verification Specialist
Yearly salary	$36,120	$33,043
Hourly rate	$17.37	$15.89
Growth rate	-4%	6%
Number of jobs	69,667	71,688
Job satisfaction	5	-
Most common degree	Bachelor's Degree, 32%	Associate Degree, 27%
Average age	40	46
Years of experience	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 verification specialist do?

An insurance verification specialist is responsible for confirming a patient's insurance details and eligibility to receive medical care services. Insurance verification specialists review the insurance documents of the patients, including its coverage and limitations, and escalate concerns to the supervisor for immediate resolution. They process paperwork accordingly upon coordinating with the patients and attending health professionals. An insurance verification specialist must have excellent communication and organizational skills, finishing administrative tasks efficiently under minimal supervision.

Prior authorization specialist vs insurance verification specialist salary

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

	Prior Authorization Specialist	Insurance Verification Specialist
Average salary	$36,120	$33,043
Salary range	Between $27,000 And $46,000	Between $28,000 And $37,000
Highest paying City	Framingham, MA	Madison, WI
Highest paying state	Massachusetts	New Hampshire
Best paying company	Washington State University	St. Luke's Cataract & Laser Institute
Best paying industry	Health Care	Pharmaceutical

Differences between prior authorization specialist and insurance verification specialist education

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

	Prior Authorization Specialist	Insurance Verification Specialist
Most common degree	Bachelor's Degree, 32%	Associate Degree, 27%
Most common major	Nursing	Health Care Administration
Most common college	University of Southern California	University of Pennsylvania

Prior authorization specialist vs insurance verification specialist demographics

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

	Prior Authorization Specialist	Insurance Verification Specialist
Average age	40	46
Gender ratio	Male, 18.4% Female, 81.6%	Male, 11.4% Female, 88.6%
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, 9.3% Unknown, 3.6% Hispanic or Latino, 16.0% Asian, 4.9% White, 66.1% American Indian and Alaska Native, 0.1%
LGBT Percentage	7%	7%

Differences between prior authorization specialist and insurance verification 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.

Insurance verification specialist example responsibilities.

Check CPT and ICD-10 codes with LCD and policies from multiple insurance companies to make sure procedures will be paid.
Support the patient privacy/confidentiality policies and regulations under HIPAA for patients and their medical records.
Confirm correct charges base on HCPCS codes.
Assist callers as well with questions about their benefits, terms and conditions of medical plans, appeals and grievances.
Provide medical record support in the absence of EMR: assist clinics and hospitals in obtaining medical records in appropriate format.
Document outbound communication from providers and veterans.

Prior authorization specialist vs insurance verification 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 insurance verification specialist skills

Patients, 25%
Insurance Verification, 15%
Customer Service, 7%
Insurance Eligibility, 5%
Data Entry, 4%
Medical Terminology, 4%

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Prior Authorization Specialist
Prior Authorization Specialist vs Insurance Verification Specialist

Updated January 8, 2025

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