Payor Clearance Specialist – Access & Authorization Expert

Children's National Hospital; Washington (District of Columbia); On-site; USD 43,000 - 72,000; Full time

Job summary

Children’s National Hospital is seeking Payor Clearance Associates to join the Revenue Cycle team. You will work with referring physician offices, payers, and patients to ensure pre-service payor clearance and accurate pre-certifications.

The role emphasizes attention to detail, strong communication, and knowledge of CPT/ICD terminology, insurance plans, and billing processes to minimize denials and accelerate access to care.

Qualifications

• High School Diploma or GED required.
• 2 years healthcare experience with payor navigation, claims and billing, and authorization processes.
• 2 years CPT, ICD coding and medical terminology experience.
• 2 years knowledge of medical insurance plans and managed care plans.

Responsibilities

• Pre-service payor clearance: obtain authorizations and verify coverage prior to services.
• Pre-register patients, verify eligibility and benefits, and collect patient balances.
• Communicate with physicians, patients, and payors to resolve barriers to care and payment.
• Review documentation to support clinical decisions and reduce denials.
• Collaborate with Payor Nurse Navigators and other departments to minimize delays and improve outcomes.

Skills

Communication

Customer service

Interpersonal skills

Attention to detail

Problem solving

Confidentiality

Insurance requirements

EMR software

Education

High School Diploma or GED

Tools

EMRs

Job description

Children’s National Hospital is seeking Payor Clearance Associates to join the Revenue Cycle team. You will work with referring physician offices, payers, and patients to ensure pre-service payor clearance and accurate pre-certifications.

The role emphasizes attention to detail, strong communication, and knowledge of CPT/ICD terminology, insurance plans, and billing processes to minimize denials and accelerate access to care.