Payor Clearance Specialist

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

Job summary

Children's National Medical Center in Silver Spring, MD is hiring for a Payor Clearance Associate on the Revenue Cycle team. The role focuses on payor navigation, financial clearance, and ensuring patient access prior to services.

You will verify eligibility and benefits, obtain authorizations, and communicate with physicians, payers, and patients to reduce barriers and improve financial outcomes for scheduled services.

Qualifications

• 2 years healthcare experience with payor navigation, claims and billing, healthcare registration, insurance referral and authorization processes, and appeals.
• 2 years experience related to CPT, ICD coding assignment, and medical terminology.
• 2 years comprehensive medical and insurance terminology and working knowledge of medical insurance plans.

Responsibilities

• Navigate payor COB issues prior to services to ensure proper claims payments and obtain/verify authorizations on file.
• Provide supporting clinical information to insurance payors to reduce peer-to-peer reviews.
• Collaborate with Payor Nurse Navigators to decrease delays in patient access.
• Verify insurance eligibility and benefits using real-time tools and payer websites; document responses.
• Communicate with physicians' offices, patients and carriers in a professional manner.
• Pre-register patients, verify benefits, and collect patient responsibility as needed.

Skills

Payor navigation

Medical terminology

Insurance terminology

Customer service

Communication

EMR experience

Bilingual preferred

Confidentiality

Education

High School Diploma

Tools

EMR software

Job description

Children's National Medical Center in Silver Spring, MD is hiring for a Payor Clearance Associate on the Revenue Cycle team. The role focuses on payor navigation, financial clearance, and ensuring patient access prior to services.

You will verify eligibility and benefits, obtain authorizations, and communicate with physicians, payers, and patients to reduce barriers and improve financial outcomes for scheduled services.