What does an Authorization Specialist do?
An authorization specialist is responsible for reviewing insurance claims and determining the necessary settlement for the clients and involved parties. Authorization specialists file documents and gather the required information for further investigation and analysis. They coordinate with the insurance agency and the medical institution and ensure that the correct communications are being sent out for reference. An authorization specialist must have excellent communication and organizational skills, especially in writing authorization requests and resolve claims timely and efficiently.
Authorization specialist responsibilities
Here are examples of responsibilities from real authorization specialist resumes:
- Demonstrate knowledge of HIPAA by appropriately managing patient confidentiality.
- Utilize CMS and InterQual criteria to establish authorizations for members requiring medical services for a Medicare advantage insurance company.
- Build authorization, match ICD-10 codes with there procedure codes
- Provide patients with patient registration forms in order to follow up on patient check-in and check-out utilizing a proprietary management system.
- Obtain verification of insurance coverage and authorizations for clinical visits and surgical procedures for patients.
- Perform all components of the office registration including arrival, check-in and future appointments.
- Assign appropriate ICD-9 codes to all identify diagnoses, research and enter prescriptions as instructed.
- Verify daily billing submission report for insurances, including HCPCS codes, ICD-9 codes and modifiers.
- Enter in ICD-10 codes for quotes and authorizations on inpatient outpatient procedures and referrals to outside providers.
- Provide training for all new staff members of EHR, EMR, & other computer programs used by the practice.
- Check clinical records for diagnosis, and obtain additional clinical information as needed to ensure the prescription authorization meets CMS guidelines.
- Document authorization in EMR system.
- Require familiarity with Interqual and company base criteria sets.
- Maintain HIPAA standards and ensure confidentiality of protect health information.
- Coordinate with insurance company authorization department to resolve CPT code discrepancies.
Authorization specialist skills and personality traits
We calculated that 20% of Authorization Specialists are proficient in Patients, Customer Service, and Insurance Verification. They’re also known for soft skills such as Computer skills, Listening skills, and Patience.
We break down the percentage of Authorization Specialists that have these skills listed on their resume here:
- Patients, 20%
Coordinated closely with physicians, office staff and patients to ensure timely authorization of requested services/surgeries.
- Customer Service, 10%
Delivered high-level customer service in a fast paced medical imaging facility with a high patient volume.
- Insurance Verification, 6%
Maintained accurate and up to date files that included insurance verification and patient demographics.
- Medical Terminology, 6%
Demonstrate and apply knowledge of medical terminology, high proficiency of general office procedures including HIPAA regulations.
- Insurance Eligibility, 4%
Verify patient insurance eligibility and confirming whether authorization or referrals are required for radiology outpatient testing.
- Veterans, 4%
Assist Veterans by obtaining client information; assisting in medical appointments, determining eligibility, and maintaining database.
"patients," "customer service," and "insurance verification" are among the most common skills that authorization specialists use at work. You can find even more authorization specialist responsibilities below, including:
Listening skills. Another soft skill that's essential for fulfilling authorization specialist duties is listening skills. The role rewards competence in this skill because "representatives must listen carefully to ensure that they understand customers in order to assist them." According to an authorization specialist resume, here's how authorization specialists can utilize listening skills in their job responsibilities: "interpreted and communicated clinical information to insurance companies to substantiate medical necessity. "
Patience. Another skill that relates to the job responsibilities of authorization specialists is patience. This skill is critical to many everyday authorization specialist duties, as "representatives should be patient and polite, especially when interacting with dissatisfied customers." This example from a resume shows how this skill is used: "greet patience, schedule follow up appointments, answer phone calls from patients, insurance companies and doctors. "
Problem-solving skills. A big part of what authorization specialists do relies on "problem-solving skills." You can see how essential it is to authorization specialist responsibilities because "representatives must determine solutions to customers’ problems." Here's an example of how this skill is used from a resume that represents typical authorization specialist tasks: "receive and respond to complaints about the authorization process, and resolve issues whenever possible, or refer them for resolution. "
Communication skills. A commonly-found skill in authorization specialist job descriptions, "communication skills" is essential to what authorization specialists do. Authorization specialist responsibilities rely on this skill because "customer service representatives must be able to provide clear information in writing, by phone, or in person." You can also see how authorization specialist duties rely on communication skills in this resume example: "maintained positive interaction and open communication with internal and external staff to provide elite patient care. "
Customer-service skills. While "customer-service skills" is last on this skills list, don't underestimate its importance to authorization specialist responsibilities. Much of what an authorization specialist does relies on this skill, seeing as "representatives help companies retain customers by professionally answering questions and helping to resolve complaints." Here is a resume example of how this skill is used in the everyday duties of authorization specialists: "handle incoming and outgoing calls from internal team members, insurance payers and customers related to insurance benefits and authorizations. "
The three companies that hire the most authorization specialists are:
- Lehigh Valley Health Network13 authorization specialists jobs
- Cooper University Health Care7 authorization specialists jobs
- SoutheastHEALTH
6 authorization specialists jobs
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Compare different authorization specialists
Authorization specialist vs. Patient access representative
A Patient Access Representative is the first point of contact of a patient in a hospital facility. Among the duties include the checking-in and out of a patient, gathering a patient's information for the Doctors and Nurses to use, communicates with the patient's family or caregivers, and processes insurance billing. Most of the time, A Patient Access Representative encounters the critically ill or injured which is why one must possess great communication skills and compassion.
These skill sets are where the common ground ends though. The responsibilities of an authorization specialist are more likely to require skills like "veterans," "emr," "medical necessity," and "clinical data." On the other hand, a job as a patient access representative requires skills like "patient registration," "physician orders," "health insurance," and "cycle management." As you can see, what employees do in each career varies considerably.
Patient access representatives earn the highest salaries when working in the health care industry, with an average yearly salary of $33,319. On the other hand, authorization specialists are paid more in the health care industry with an average salary of $35,974.patient access representatives tend to reach similar levels of education than authorization specialists. In fact, patient access representatives are 0.5% more likely to graduate with a Master's Degree and 0.2% more likely to have a Doctoral Degree.Authorization specialist vs. Patient care representative
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.
In addition to the difference in salary, there are some other key differences worth noting. For example, authorization specialist responsibilities are more likely to require skills like "veterans," "emr," "medical necessity," and "clinical data." Meanwhile, a patient care representative has duties that require skills in areas such as "cash management," "patient registration," "excellent interpersonal," and "rehabilitation." These differences highlight just how different the day-to-day in each role looks.
Patient care representatives earn a lower average salary than authorization specialists. But patient care representatives earn the highest pay in the technology industry, with an average salary of $36,400. Additionally, authorization specialists earn the highest salaries in the health care with average pay of $35,974 annually.patient care representatives earn similar levels of education than authorization specialists in general. They're 0.4% more likely to graduate with a Master's Degree and 0.2% more likely to earn a Doctoral Degree.Authorization specialist vs. Patient service representative
A Patient Service Representative is responsible for coordinating with patients, ensuring accuracy and satisfaction at all times. The duties of a Patient Service Representative revolves around greeting and responding to patients, offering assistance in documentation, gathering and maintaining their personal information, and even communicating with the family or guardian. They also have to collect payments and process insurance details, obtain medical history, and even keep the patients updated in various aspects. Aside from this, it is crucial for a Representative coordinate with supervisors or personnel in-charge at all times.
The required skills of the two careers differ considerably. For example, authorization specialists are more likely to have skills like "emr," "medical necessity," "clinical data," and "medical services." But a patient service representative is more likely to have skills like "excellent interpersonal," "check-in," "psr," and "patient billing."
Patient service representatives make a very good living in the health care industry with an average annual salary of $33,107. On the other hand, authorization specialists are paid the highest salary in the health care industry, with average annual pay of $35,974.When it comes to education, patient service representatives tend to earn similar degree levels compared to authorization specialists. In fact, they're 0.8% less likely to earn a Master's Degree, and 0.2% less likely to graduate with a Doctoral Degree.Authorization specialist vs. Patient representative
A patient representative is responsible for assisting the patients with their health care needs by identifying their medical concerns, assessing their medical history, and referring them to the appropriate physicians or other medical professionals for immediate treatments and further examinations. Patient representatives verify the patients' insurance information, guiding them on filling out medical forms, processing payments for medical services, and updating them for the release of medical results. A patient representative must have excellent communication and organizational skills, especially when responding to patient's inquiries and concerns timely and accurately, and performing additional administrative and clerical tasks as needed.
Types of authorization specialist
Updated January 8, 2025
