Referral specialist vs patient care representative

The differences between referral specialists and patient care representatives can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 1-2 years to become a referral specialist, becoming a patient care representative takes usually requires 2-4 years. Additionally, a referral specialist has an average salary of $36,143, which is higher than the $33,709 average annual salary of a patient care representative.

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

Referral specialist vs patient care representative overview

	Referral Specialist	Patient Care Representative
Yearly salary	$36,143	$33,709
Hourly rate	$17.38	$16.21
Growth rate	-8%	-4%
Number of jobs	72,016	133,317
Job satisfaction	4	-
Most common degree	Bachelor's Degree, 44%	Bachelor's Degree, 39%
Average age	49	40
Years of experience	2	4

What does a referral specialist do?

Referral specialists are responsible for ensuring patients are already cleared for specialty service office visits. They resolve registration, pre-certification, and case-related affairs before the client's appointment. Also, they give support to clinical staff to manage the administrative components of clinical referrals for many services. They must gather relevant information from financial counselors, insurance carriers, and other supplementary staff to make sure the patient's financial responsibility for services are provided. Additionally, they act as a liaison between the patients, physicians, hospitals, health insurance vendors, or other referral sources.

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.

Referral specialist vs patient care representative salary

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

	Referral Specialist	Patient Care Representative
Average salary	$36,143	$33,709
Salary range	Between $29,000 And $43,000	Between $27,000 And $41,000
Highest paying City	Washington, DC	Boston, MA
Highest paying state	Connecticut	Alaska
Best paying company	Cognizant	Massachusetts General Hospital
Best paying industry	Non Profits	Technology

Differences between referral specialist and patient care representative education

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

	Referral Specialist	Patient Care Representative
Most common degree	Bachelor's Degree, 44%	Bachelor's Degree, 39%
Most common major	Business	Business
Most common college	-	University of Pennsylvania

Referral specialist vs patient care representative demographics

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

	Referral Specialist	Patient Care Representative
Average age	49	40
Gender ratio	Male, 15.3% Female, 84.7%	Male, 17.1% Female, 82.9%
Race ratio	Black or African American, 9.6% Unknown, 3.8% Hispanic or Latino, 12.0% Asian, 3.8% White, 70.6% American Indian and Alaska Native, 0.4%	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	9%	7%

Differences between referral specialist and patient care representative duties and responsibilities

Referral specialist example responsibilities.

Manage assignments of paying medical bills limit in depth that include organizing and researching regulations as pertain to veterans eligibility.
Interview patients, evaluate eligibility, collect co-pays, deductibles, including, but not limit to insurance verification.
Input HIPAA information, call physician offices to verify testing, collect copay's and deductibles.
Arrange for debt repayments or establish repayment schedules and send out insurance claims with the correct ICD-9 and CPT codes.
Research referrals and either deny or approve based on information obtain and appropriately identify diagnosis (CPT and ICD-9 coding).
Maintain confidentiality by following all applicable HIPAA regulations.

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.

Referral specialist vs patient care representative skills

Common referral specialist skills

Patients, 17%
Customer Service, 12%
Medical Terminology, 9%
PET, 6%
Patient Care, 3%
Data Entry, 3%

Common patient care representative skills

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

Referral Specialist vs. similar jobs

Referral Specialist related careers

Referral Specialist related jobs

What similar roles do

Zippia Careers
Office and Administrative Industry
Referral Specialist
Referral Specialist vs Patient Care Representative

Updated January 8, 2025

Browse office and administrative jobs