Prior authorization specialist vs patient service specialist

The differences between prior authorization specialists and patient service specialists 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 specialist. Additionally, a prior authorization specialist has an average salary of $36,120, which is higher than the $33,563 average annual salary of a patient service specialist.

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

Prior authorization specialist vs patient service specialist overview

	Prior Authorization Specialist	Patient Service Specialist
Yearly salary	$36,120	$33,563
Hourly rate	$17.37	$16.14
Growth rate	-4%	-4%
Number of jobs	69,667	105,915
Job satisfaction	5	-
Most common degree	Bachelor's Degree, 32%	Bachelor's Degree, 36%
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 specialist do?

A patient service representative serves as a patient's primary point of contact in a hospital or clinic, ensuring accuracy and customer satisfaction. They are mainly responsible for gathering a patient's information and medical history, verifying insurance forms, managing accounts, and processing payments, arranging appointments, and even performing reminder calls and correspondence. There are also instances when a patient service representative must discuss situations to patients and their families, and even alert the doctors when a patient displays strange or unlikely behavior.

Prior authorization specialist vs patient service specialist salary

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

	Prior Authorization Specialist	Patient Service Specialist
Average salary	$36,120	$33,563
Salary range	Between $27,000 And $46,000	Between $27,000 And $40,000
Highest paying City	Framingham, MA	Springfield, MA
Highest paying state	Massachusetts	Massachusetts
Best paying company	Washington State University	Virginia Eye Institute
Best paying industry	Health Care	Health Care

Differences between prior authorization specialist and patient service specialist education

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

	Prior Authorization Specialist	Patient Service Specialist
Most common degree	Bachelor's Degree, 32%	Bachelor's Degree, 36%
Most common major	Nursing	Business
Most common college	University of Southern California	University of Pennsylvania

Prior authorization specialist vs patient service specialist demographics

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

	Prior Authorization Specialist	Patient Service Specialist
Average age	40	40
Gender ratio	Male, 18.4% Female, 81.6%	Male, 12.5% Female, 87.5%
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, 12.0% Unknown, 5.1% Hispanic or Latino, 21.9% Asian, 6.4% White, 54.0% American Indian and Alaska Native, 0.6%
LGBT Percentage	7%	7%

Differences between prior authorization specialist and patient service 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.

Patient service specialist example responsibilities.

Benefit coverage eligibility or concerns for patients will be complete timely to achieve identify outcomes or solutions.
Greet patients and visitors with warmth, compassion, and demonstrate commitment to exceptional service.
Provide customer service to patients via registration, co-pay and co-insurance payment collection, appointment scheduling and telephone service
Obtain patient demographic, billing, insurance, and other necessary intake information for patients seeking rehabilitation services.
Screen, triage, register and verify a high volume of client eligibility and demographic data.
Direct callers to appropriate personnel, and initiate a triage slip for response by medical personnel.

Prior authorization specialist vs patient service 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 patient service specialist skills

Patients, 20%
Patient Service, 9%
Physical Therapy, 8%
Rehabilitation, 8%
Patient Appointments, 8%
Front Desk, 7%

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Prior Authorization Specialist
Prior Authorization Specialist vs Patient Service Specialist

Updated January 8, 2025

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