Payor Clearance Specialist

10100 Children's Hospital; United States; On-site; USD 43,000 - 72,000; Full time

Job summary

Children’s National Hospital in Silver Spring, MD seeks a Payor Clearance Associate to join the Revenue Cycle team. You will complete patient access workflows, verify insurance eligibility, obtain authorizations, and collect patient responsibility prior to services.

In this role you will work with physicians, payers, and patients to ensure payor clearance, reduce denial risks, and support timely claims. Minimum 2 years healthcare experience required.

Qualifications

• High School Diploma or GED required.
• 2 years healthcare experience with payor navigation, claims and billing, and insurance registration/authorization processes.
• 2 years CPT/ICD coding and medical terminology experience.
• Knowledge of insurance requirements and government/non-government carriers.
• Bilingual abilities preferred.

Responsibilities

• Pre-service payor clearance and pre-registration; verify insurance eligibility and benefits.
• Obtain authorizations for add-on cases to ensure timely claims payment.
• Provide payer documentation to support appeals and denials management.
• Collaborate with Payor Nurse Navigators to reduce delays in access to care.
• Document payer verification responses and communicate patient financial responsibilities.

Skills

Communication

Customer service

Interpersonal skills

Telephone skills

Education

High School Diploma or GED

Tools

EMR software

Job description

Children’s National Hospital in Silver Spring, MD seeks a Payor Clearance Associate to join the Revenue Cycle team. You will complete patient access workflows, verify insurance eligibility, obtain authorizations, and collect patient responsibility prior to services.

In this role you will work with physicians, payers, and patients to ensure payor clearance, reduce denial risks, and support timely claims. Minimum 2 years healthcare experience required.