Prior authorization specialist vs registration representative

The differences between prior authorization specialists and registration 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 registration representative. Additionally, a prior authorization specialist has an average salary of $36,120, which is higher than the $34,021 average annual salary of a registration representative.

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

Prior authorization specialist vs registration representative overview

	Prior Authorization Specialist	Registration Representative
Yearly salary	$36,120	$34,021
Hourly rate	$17.37	$16.36
Growth rate	-4%	-4%
Number of jobs	69,667	118,803
Job satisfaction	5	-
Most common degree	Bachelor's Degree, 32%	Bachelor's Degree, 35%
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 registration representative do?

In medical facilities, a registration representative serves as the patients' first point of contact in clinics and hospitals. They primarily greet patients, identify their needs, gather personal and medical information, and assist them in filling out forms. They must also handle admission and discharge procedures, process payments, arrange payment plans, and collect insurance information. Furthermore, as a registered representative, it is essential to maintain an active communication line with staff for a smooth and efficient workflow.

Prior authorization specialist vs registration representative salary

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

	Prior Authorization Specialist	Registration Representative
Average salary	$36,120	$34,021
Salary range	Between $27,000 And $46,000	Between $26,000 And $42,000
Highest paying City	Framingham, MA	Boston, MA
Highest paying state	Massachusetts	Massachusetts
Best paying company	Washington State University	UMass Memorial Health
Best paying industry	Health Care	Health Care

Differences between prior authorization specialist and registration representative education

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

	Prior Authorization Specialist	Registration Representative
Most common degree	Bachelor's Degree, 32%	Bachelor's Degree, 35%
Most common major	Nursing	Business
Most common college	University of Southern California	University of Pennsylvania

Prior authorization specialist vs registration representative demographics

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

	Prior Authorization Specialist	Registration Representative
Average age	40	40
Gender ratio	Male, 18.4% Female, 81.6%	Male, 13.9% Female, 86.1%
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, 11.6% Unknown, 4.9% Hispanic or Latino, 21.3% Asian, 6.4% White, 55.2% American Indian and Alaska Native, 0.6%
LGBT Percentage	7%	7%

Differences between prior authorization specialist and registration 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.

Registration representative example responsibilities.

Work with third party payer requirements including Medicare, Medicaid (AHCCCS), manage care plans, and commercial plans.
Manage and update demographic and insurance information, including authorizations and referrals, while demonstrating HIPPA confidentiality regulations.
Verify eligibility and insurance benefits for patients, including Medicare, Medicaid, private insurance and workers' compensation.
Maintain patient privacy in accordance with HIPAA with a high level of professionalism, compassion, productivity, and accuracy.
Maintain proficient level of knowledge regarding Medicare requirements, HIPAA compliance and reimbursement criteria.
Complete registration process for inpatients, outpatients, and emergency patients accurately and efficiently in accordance with policies and procedures.

Prior authorization specialist vs registration 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 registration representative skills

Patients, 25%
Medical Terminology, 10%
Patient Care, 6%
Customer Service, 6%
Health Insurance, 5%
Patient Registration, 4%

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Prior Authorization Specialist
Prior Authorization Specialist vs Registration Representative

Updated January 8, 2025

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