Payer Clearance Specialist — Healthcare Revenue Cycle

Children's National Hospital; Silver Spring (MD); On-site; USD 43,000 - 72,000; Full time

Job summary

Children’s National Hospital in Silver Spring, MD is seeking Payor Clearance Associates to join the Revenue Cycle team. You will ensure payor clearance before services, verify eligibility, obtain authorizations, and coordinate with physicians, payers, and patients to minimize barriers.

The role emphasizes pre-service clearance, communication with insurance carriers, support for CPT/ICD coding understanding, and producing outcomes that reduce peer-to-peer reviews.

Qualifications

• High School Diploma or GED required.
• 2 years healthcare experience with payor navigation, claims and billing, and insurance processes.
• 2 years CPT/ICD coding and medical terminology experience.
• Comprehensive medical and insurance terminology; knowledge of government and non-government provider plans.
• Bilingual abilities preferred.

Responsibilities

• Pre-Service Payor Clearance: ensure all authorizations are on file before services.
• Verify insurance eligibility and benefits; preregister patients and collect patient responsibility.
• Obtain add-on authorizations; follow up to ensure procedures were authorized and paid.
• Provide supporting clinical information to payors; reduce peer-to-peer reviews.
• Act as liaison to resolve custodial barriers and communicate with payers.

Skills

Communication skills

Customer service

Verbal communication

Attention to detail

Problem solving

Confidentiality

EMR experience

Bilingual

Education

High School Diploma or GED

Tools

EMR systems

Job description

Children’s National Hospital in Silver Spring, MD is seeking Payor Clearance Associates to join the Revenue Cycle team. You will ensure payor clearance before services, verify eligibility, obtain authorizations, and coordinate with physicians, payers, and patients to minimize barriers.

The role emphasizes pre-service clearance, communication with insurance carriers, support for CPT/ICD coding understanding, and producing outcomes that reduce peer-to-peer reviews.