Payor Clearance Specialist

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

Job summary

Children's National Hospital is seeking a Payor Clearance Associate to join the Eligibility and Financial Clearance team. You will navigate payor requirements, obtain authorizations, pre-register patients, and collect patient responsibilities to ensure timely access to scheduled services.

Role involves coordinating with physicians, payers, and the CNMC departments to minimize barriers, improve denial trends, and support favorable financial outcomes for care.

Qualifications

• Minimum education: High School Diploma or GED.
• Must have 2 years healthcare experience with payor navigation, claims and billing, registration, referrals and authorizations.
• Understanding of CPT, ICD coding and medical terminology.

Responsibilities

• Pre-Service Payor Clearance: verify eligibility, obtain authorizations, pre-register patients, and collect patient responsibilities.
• Payor and patient navigation to resolve barriers and ensure timely access to services.
• Review documentation to support outcomes and reduce peer-to-peer reviews.
• Communicate with payors and CNMC departments to expedite approvals and payments.
• Provide education to providers on payer requirements and clinical documentation.
• Assist patients by scheduling and coordinating care and pre-certifications.

Skills

Communication

Customer service

Verbal skills

Healthcare setting

Attention to detail

Problem solving

Confidentiality

Insurance knowledge

EMR proficiency

Education

High School Diploma or GED

Tools

EMR systems

Job description

Children's National Hospital is seeking a Payor Clearance Associate to join the Eligibility and Financial Clearance team. You will navigate payor requirements, obtain authorizations, pre-register patients, and collect patient responsibilities to ensure timely access to scheduled services.

Role involves coordinating with physicians, payers, and the CNMC departments to minimize barriers, improve denial trends, and support favorable financial outcomes for care.