Reimbursement specialist vs prior authorization specialist

The differences between reimbursement specialists and prior authorization specialists can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 6-12 months to become a reimbursement specialist, becoming a prior authorization specialist takes usually requires 2-4 years. Additionally, a reimbursement specialist has an average salary of $38,273, which is higher than the $36,120 average annual salary of a prior authorization specialist.

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

Reimbursement specialist vs prior authorization specialist overview

	Reimbursement Specialist	Prior Authorization Specialist
Yearly salary	$38,273	$36,120
Hourly rate	$18.40	$17.37
Growth rate	11%	-4%
Number of jobs	32,292	69,667
Job satisfaction	-	5
Most common degree	Bachelor's Degree, 40%	Bachelor's Degree, 32%
Average age	45	40
Years of experience	12	4

What does a reimbursement specialist do?

A reimbursement specialist is responsible for analyzing insurance documents, processing reimbursement claims, and releasing accurate billing statements for insurance claims. Reimbursement specialists must have excellent analytical skills, especially on performing clerical tasks to evaluate insurance cases, investigate cases, and update the account information of the clients on the database. They should also have impeccable communication skills and understanding of the insurance processes to be able to coordinate with the clients, explaining the procedures of their claims accurately, and coordinate with the insurance management to improve the claims processes.

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.

Reimbursement specialist vs prior authorization specialist salary

Reimbursement specialists and prior authorization specialists have different pay scales, as shown below.

	Reimbursement Specialist	Prior Authorization Specialist
Average salary	$38,273	$36,120
Salary range	Between $29,000 And $49,000	Between $27,000 And $46,000
Highest paying City	Lynchburg, VA	Framingham, MA
Highest paying state	Virginia	Massachusetts
Best paying company	Novartis	Washington State University
Best paying industry	Pharmaceutical	Health Care

Differences between reimbursement specialist and prior authorization specialist education

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

	Reimbursement Specialist	Prior Authorization Specialist
Most common degree	Bachelor's Degree, 40%	Bachelor's Degree, 32%
Most common major	Business	Nursing
Most common college	University of Pennsylvania	University of Southern California

Reimbursement specialist vs prior authorization specialist demographics

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

	Reimbursement Specialist	Prior Authorization Specialist
Average age	45	40
Gender ratio	Male, 15.2% Female, 84.8%	Male, 18.4% Female, 81.6%
Race ratio	Black or African American, 9.8% Unknown, 4.2% Hispanic or Latino, 16.9% Asian, 8.1% White, 59.8% American Indian and Alaska Native, 1.3%	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%
LGBT Percentage	9%	7%

Differences between reimbursement specialist and prior authorization specialist duties and responsibilities

Reimbursement specialist example responsibilities.

Manage the EDI clearinghouse rejections.
Process department payroll, order supplies, and manage petty-cash funds.
Manage use of various systems, such as MEDITECH, Cerner, WebNow, and yield-base follow-up tool.
Manage cases by aggressively directing the litigation process.
Negotiate fee structure for manage care contracts on acute and rehabilitation facilities.
Research medical coding ICD-9, ICD-10, HCPCS and CPT-4 to let client know the outcome of medical claim.

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.

Reimbursement specialist vs prior authorization specialist skills

Common reimbursement specialist skills

Patients, 20%
Customer Service, 9%
Appeals, 6%
CPT, 5%
Medicare, 4%
Medicaid, 4%

Common prior authorization specialist skills

Patients, 18%
Customer Service, 8%
Medical Necessity, 8%
Medical Terminology, 6%
Clinical Resource, 6%
Authorization Process, 4%

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Reimbursement Specialist
Reimbursement Specialist vs Prior Authorization Specialist

Updated January 8, 2025

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