Prior authorization specialist vs medical billing clerk

The differences between prior authorization specialists and medical billing clerks 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 medical billing clerk takes usually requires 1-2 years. Additionally, a prior authorization specialist has an average salary of $36,120, which is higher than the $33,566 average annual salary of a medical billing clerk.

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

Prior authorization specialist vs medical billing clerk overview

	Prior Authorization Specialist	Medical Billing Clerk
Yearly salary	$36,120	$33,566
Hourly rate	$17.37	$16.14
Growth rate	-4%	-3%
Number of jobs	69,667	164,870
Job satisfaction	5	-
Most common degree	Bachelor's Degree, 32%	Associate 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 medical billing clerk do?

A medical billing clerk is primarily in charge of processing payments and creating billing arrangements in clinics and hospitals. Among their responsibilities include gathering and verifying patient identification, handling insurance information, coding, updating databases, and maintaining records. It is also their responsibility to assist patients by filling out forms, answering their inquiries, and referring them to other services. Moreover, a medical billing clerk must monitor patient accounts and follow-up on delinquent patient accounts, coordinating with collection agencies as needed.

Prior authorization specialist vs medical billing clerk salary

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

	Prior Authorization Specialist	Medical Billing Clerk
Average salary	$36,120	$33,566
Salary range	Between $27,000 And $46,000	Between $27,000 And $40,000
Highest paying City	Framingham, MA	San Leandro, CA
Highest paying state	Massachusetts	Washington
Best paying company	Washington State University	iCare
Best paying industry	Health Care	Health Care

Differences between prior authorization specialist and medical billing clerk education

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

	Prior Authorization Specialist	Medical Billing Clerk
Most common degree	Bachelor's Degree, 32%	Associate Degree, 30%
Most common major	Nursing	Health Care Administration
Most common college	University of Southern California	Stanford University

Prior authorization specialist vs medical billing clerk demographics

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

	Prior Authorization Specialist	Medical Billing Clerk
Average age	40	46
Gender ratio	Male, 18.4% Female, 81.6%	Male, 11.3% Female, 88.7%
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, 21.9% Asian, 6.8% White, 55.8% American Indian and Alaska Native, 0.8%
LGBT Percentage	7%	7%

Differences between prior authorization specialist and medical billing clerk 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.

Medical billing clerk example responsibilities.

Accept and process healthcare claims and confidential medical records; verify patient eligibility and manage the Medicare and Medicaid billing process.
Interact with patients as part of the quality assurance process (follow-up, EHR confirmation, billing confirmation).
Reconcile insurance and patient payments while researching and resolving incorrect payments, EOB rejections, and assort issues with outstanding accounts.
Utilize medical terminology and follow HIPAA guidelines.
Bill Magellan through Nextgen system.
Double checked CMS-1500 form before posting it out to the insurance companies.

Prior authorization specialist vs medical billing clerk skills

Common prior authorization specialist skills

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

Common medical billing clerk skills

Patients, 18%
Medical Billing, 10%
Healthcare, 7%
Data Entry, 7%
Customer Service, 6%
Medicaid, 5%

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Prior Authorization Specialist
Prior Authorization Specialist vs Medical Billing Clerk

Updated January 8, 2025

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