What does a prior authorization specialist do?

Billers are medical professionals who are responsible for translating health care services into medical claims to be submitted to insurance companies. These billers are required to obtain patient medical records and interpret them to determine the billable units and services. They must manage all aspects of the medical billing process and make necessary contacts with insurance payers or patients to ensure maximum reimbursements. Billers must also provide services that are associated with internal and external customer billing and payment processing operations.

There are some key differences in the responsibilities of each position. For example, prior authorization specialist responsibilities require skills like "medical necessity," "clinical judgment," "medical terminology," and "clinical resource." Meanwhile a typical biller has skills in areas such as "patient accounts," "medical billing," "math," and "billing process." This difference in skills reveals the differences in what each career does.

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.

In addition to the difference in salary, there are some other key differences worth noting. For example, prior authorization specialist responsibilities are more likely to require skills like "medical necessity," "clinical judgment," "clinical resource," and "authorization process." Meanwhile, a medical billing clerk has duties that require skills in areas such as "medical billing," "healthcare," "patient accounts," and "medical claims." These differences highlight just how different the day-to-day in each role looks.

A billing representative assists with the overall operations of the organization's billing department. Billing representatives post payments timely on the database, update account statements, generate financial reports, release invoices, and resolve account discrepancies. They also perform client accounts reconciliation as needed, monitor account receivables, review overdated balance, and notify clients of payment updates to ensure accurate and timely billing. A billing representative must have strong analytical and communication skills to manage clients' accounts, as well as comprehensive knowledge on the accounting industry to explain the payment terms and policies of an organization to a client.

The required skills of the two careers differ considerably. For example, prior authorization specialists are more likely to have skills like "medical necessity," "clinical judgment," "clinical resource," and "authorization process." But a billing representative is more likely to have skills like "medical billing," "patient accounts," "medical claims," and "billing system."

An insurance coordinator is responsible for evaluating and validating insurance information to verify claims and process the necessary claims resolutions for parties. Insurance coordinators submit claims statements timely to the insurance officers for review, coordinate with the clients for inquiries and updates, and reach out to medical institutions for accurate filing of payments. An insurance coordinator must have excellent communication and analytical skills to assess reports, resolve claims discrepancies, and escalate high-level complaints to the officers for immediate action.