Payor Clearance Navigator

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

Job summary

Children’s National Medical Center is seeking a Payor Clearance Associate within the 10119 Eligibility and Financial Clearance department. This role focuses on patient access, insurance pre-authorization, and payer verification to ensure timely, accurate service delivery across the health system.

Ideal candidates will have a high school diploma and at least two years of healthcare experience related to payor navigation, CPT/ICD coding, and medical terminology.

Qualifications

• Requires high school diploma or GED.
• 2 years healthcare experience with payor navigation and billing.
• 2 years CPT/ICD coding and medical terminology experience.
• 2 years knowledge of medical insurance plans and managed care.

Responsibilities

• Navigate and address payor COB issues to ensure proper claims payments; obtain/preauthorize authorizations prior to services.
• Obtain add-on case authorizations and follow up to ensure procedures were performed.
• Provide supporting clinical information to insurance payors to reduce peer-to-peer reviews.
• Coordinate with Payor Nurse Navigators to minimize delays in patient access to care.
• Review clinical documentation to ensure alignment with outcomes and payer requirements.

Skills

Excellent communication

Customer service

Verbal interpersonal skills

Attention to detail

Problem solving

Confidentiality compliance

EMR knowledge

Medical terminology

Insurance payor navigation

Education

High School Diploma or GED

Job description

Children’s National Medical Center is seeking a Payor Clearance Associate within the 10119 Eligibility and Financial Clearance department. This role focuses on patient access, insurance pre-authorization, and payer verification to ensure timely, accurate service delivery across the health system.

Ideal candidates will have a high school diploma and at least two years of healthcare experience related to payor navigation, CPT/ICD coding, and medical terminology.