Prior authorization specialist vs patient care representative

The differences between prior authorization specialists and patient care representatives 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 a patient care representative. Additionally, a prior authorization specialist has an average salary of $36,120, which is higher than the $33,709 average annual salary of a patient care representative.

The top three skills for a prior authorization specialist include patients, customer service and medical necessity. The most important skills for a patient care representative are patients, patient care, and home health.

Prior authorization specialist vs patient care representative overview

	Prior Authorization Specialist	Patient Care Representative
Yearly salary	$36,120	$33,709
Hourly rate	$17.37	$16.21
Growth rate	-4%	-4%
Number of jobs	69,667	133,317
Job satisfaction	5	-
Most common degree	Bachelor's Degree, 32%	Bachelor's Degree, 39%
Average age	40	40
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 a patient care representative do?

PCRs (Patient Care Representatives) are given responsibilities like updating and verifying patient information after every visit, scheduling and reminding patients about appointments, and informing patients about delays and how long the estimated waiting times will be. They are also responsible for obtaining patients' personal information like their address, contact details, insurance information, and medical and surgical history. They must be able to communicate with patients, family members, and medical staff to give them all the information they need to treat the person looking for medical help.

Prior authorization specialist vs patient care representative salary

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

	Prior Authorization Specialist	Patient Care Representative
Average salary	$36,120	$33,709
Salary range	Between $27,000 And $46,000	Between $27,000 And $41,000
Highest paying City	Framingham, MA	Boston, MA
Highest paying state	Massachusetts	Alaska
Best paying company	Washington State University	Massachusetts General Hospital
Best paying industry	Health Care	Technology

Differences between prior authorization specialist and patient care representative education

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

	Prior Authorization Specialist	Patient Care Representative
Most common degree	Bachelor's Degree, 32%	Bachelor's Degree, 39%
Most common major	Nursing	Business
Most common college	University of Southern California	University of Pennsylvania

Prior authorization specialist vs patient care representative demographics

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

	Prior Authorization Specialist	Patient Care Representative
Average age	40	40
Gender ratio	Male, 18.4% Female, 81.6%	Male, 17.1% Female, 82.9%
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, 12.5% Unknown, 5.1% Hispanic or Latino, 20.3% Asian, 6.3% White, 55.2% American Indian and Alaska Native, 0.6%
LGBT Percentage	7%	7%

Differences between prior authorization specialist and patient care 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.

Patient care representative example responsibilities.

Manage cash and co-payments accurately and discharge patients providing them with proper medical notes and information before exiting.
Verify insurance, Medicaid, Medicare, register patients, and code proper ICD-9 and CPT codes on encounters.
Utilize medical terminology, CPT, HCPC and ICD-9 and patient information into new authorizations.
Interview patients to gather information pertinent to their Medicaid application.
Screen, identify, and enter ICD-9 coding from treatment record forms.
Maintain patient confidentiality and follow HIPAA rules.

Prior authorization specialist vs patient care 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 patient care representative skills

Patients, 25%
Patient Care, 13%
Home Health, 7%
Cash Management, 5%
Phone Calls, 4%
CPT, 3%

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Prior Authorization Specialist
Prior Authorization Specialist vs Patient Care Representative

Updated January 8, 2025

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