Payor Clearance & Authorization Specialist

Children's National Hospital; Silver Spring (MD); On-site; USD 49,000 - 81,000; Full time

Job summary

Children's National Hospital in Silver Spring, MD seeks a Payor Clearance Specialist to navigate insurance payor regulations and ensure full payor clearance before services.

You will pre-register patients, verify eligibility, obtain authorizations, and communicate with physicians, payers, and patients to reduce barriers and improve revenue cycle outcomes.

This role requires 3+ years healthcare experience with payor navigation and CPT/ICD coding knowledge; Cerner/EMR experience preferred.

Qualifications

• High School Diploma or GED required.
• 3 years healthcare experience with payor navigation, claims and billing, healthcare registration, insurance referral and authorization processes.
• 2 years experience related to CPT and ICD coding.

Responsibilities

• Pre-Service Payor Clearance: verify eligibility, obtain authorizations, and address payor COB issues before service.
• Pre-register patients, verify insurance eligibility and benefits, and collect patient responsibility amounts.
• Communicate with physicians, payers, and patients to reduce delays and improve revenue cycle outcomes.
• Review denials and provide documentation to support authorizations; submit appeals when needed.

Skills

Communication skills

Customer service

Attention to detail

Problem solving

Teamwork

Education

High School Diploma or GED

Tools

Cerner

Passport

EMR systems

Job description

Children's National Hospital in Silver Spring, MD seeks a Payor Clearance Specialist to navigate insurance payor regulations and ensure full payor clearance before services.

You will pre-register patients, verify eligibility, obtain authorizations, and communicate with physicians, payers, and patients to reduce barriers and improve revenue cycle outcomes.

This role requires 3+ years healthcare experience with payor navigation and CPT/ICD coding knowledge; Cerner/EMR experience preferred.