Prior authorization specialist vs patient service representative

The differences between prior authorization specialists and patient service 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 service representative. Additionally, a prior authorization specialist has an average salary of $36,120, which is higher than the $32,476 average annual salary of a patient service representative.

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

Prior authorization specialist vs patient service representative overview

	Prior Authorization Specialist	Patient Service Representative
Yearly salary	$36,120	$32,476
Hourly rate	$17.37	$15.61
Growth rate	-4%	-4%
Number of jobs	69,667	165,920
Job satisfaction	5	-
Most common degree	Bachelor's Degree, 32%	Bachelor's Degree, 32%
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 service representative do?

A Patient Service Representative is responsible for coordinating with patients, ensuring accuracy and satisfaction at all times. The duties of a Patient Service Representative revolves around greeting and responding to patients, offering assistance in documentation, gathering and maintaining their personal information, and even communicating with the family or guardian. They also have to collect payments and process insurance details, obtain medical history, and even keep the patients updated in various aspects. Aside from this, it is crucial for a Representative coordinate with supervisors or personnel in-charge at all times.

Prior authorization specialist vs patient service representative salary

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

	Prior Authorization Specialist	Patient Service Representative
Average salary	$36,120	$32,476
Salary range	Between $27,000 And $46,000	Between $27,000 And $38,000
Highest paying City	Framingham, MA	Seattle, WA
Highest paying state	Massachusetts	Vermont
Best paying company	Washington State University	University of California, Berkeley
Best paying industry	Health Care	Health Care

Differences between prior authorization specialist and patient service representative education

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

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

Prior authorization specialist vs patient service representative demographics

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

	Prior Authorization Specialist	Patient Service Representative
Average age	40	40
Gender ratio	Male, 18.4% Female, 81.6%	Male, 11.9% Female, 88.1%
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, 10.3% Unknown, 5.3% Hispanic or Latino, 21.5% Asian, 6.3% White, 55.7% American Indian and Alaska Native, 0.7%
LGBT Percentage	7%	7%

Differences between prior authorization specialist and patient service 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 service representative example responsibilities.

Manage the daily release of charges to A/R.
Adhere with all state and federal regulations such as EMTALA and HIPPA requirements and appropriately collect co-payments and deductibles from patients.
Provide caring and compassion to elderly and developmentally disable patients.
Demonstrate respect, compassion and confidentiality for patients and family members.
Provide professional and accurate service to schedule patient appointments, check-in and verify insurance eligibility.
Provide quality customer service to patients and observe all protocols regarding HIPPA regulations to ensure patient confidentiality.

Prior authorization specialist vs patient service 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 service representative skills

Patients, 20%
Customer Service, 12%
Excellent Interpersonal, 7%
Check-In, 7%
Patient Service, 6%
Excellent Organizational, 6%

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Prior Authorization Specialist
Prior Authorization Specialist vs Patient Service Representative

Updated January 8, 2025

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