Payor Authorization & Clearance Specialist

10100 Children's Hospital; United States; On-site; USD 49,000 - 81,000; Full time

Benefits offered by this job

Comprehensive health coverage

Generous paid time off

401(k) plan and savings accounts

Life, AD&D, long-term disability

Tuition assistance

Commuter benefits

Job summary

Children’s National Medical Center is seeking a Payor Clearance Specialist to join the Eligibility and Financial Clearance team. You will navigate payer requirements, obtain authorizations, verify insurance benefits, and secure pre-certifications before services are rendered to ensure accurate patient financial responsibility.

This role supports inpatient, ambulatory, and physician practice settings, collaborates with referring offices, payers, and patients, and uses auditing tools to identify

Qualifications

• High school diploma or GED required.
• 3 years healthcare experience with payor navigation, claims and billing, insurance registration and authorization processes.
• 2 years experience related to CPT and ICD coding.
• Ability to communicate with physicians’ offices, patients and insurance carriers professionally.
• Superior customer service and professional etiquette.
• Strong verbal, interpersonal, and telephone skills.
• Experience in healthcare settings and computer knowledge.
• Attention to detail and ability to multi-task.
• Knowledge of confidentiality guidelines and CNMC policies.
• Knowledge of insurance requirements for Governmental and non-Governmental carriers.
• Cerner, Passport, or EMR systems experience preferred.
• Bilingual abilities preferred.
• Completion of Patient Access training assessments and typing requirements.

Responsibilities

• Pre-Service Payor Clearance: ensure authorizations and payor clearance prior to service.
• Verify insurance eligibility and benefits; pre-register patients.
• Communicate with payors and care teams to resolve denials and ensure timely payments.
• Provide payor documentation and support appeals.
• Work with Payor Nurse Navigators to reduce delays in access to care.
• Review denials trends and assist with corrective actions and reports.
• Ensure proper and timely authorization for add-on cases and procedures.

Skills

Communication skills

Customer service

Attention to detail

Problem solving

Verbal skills

Telephone skills

Teamwork

Bilingual abilities

Education

High School Diploma or GED

Tools

Cerner

Passport

EMR systems

Job description

Children’s National Medical Center is seeking a Payor Clearance Specialist to join the Eligibility and Financial Clearance team. You will navigate payer requirements, obtain authorizations, verify insurance benefits, and secure pre-certifications before services are rendered to ensure accurate patient financial responsibility.

This role supports inpatient, ambulatory, and physician practice settings, collaborates with referring offices, payers, and patients, and uses auditing tools to identify