Payor Clearance Specialist — Revenue Cycle

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

Job summary

Children's National Hospital is seeking a Payor Clearance Associate within the Revenue Cycle team to ensure payor clearance before services. The role collaborates with physicians, payers, and patients to navigate insurance prior authorizations and optimize access to care.

You will verify eligibility, obtain pre-certifications, register patients, and support denial management while maintaining CNMC confidentiality and high-quality customer service.

Qualifications

• High School Diploma or GED required.
• 2 years healthcare experience with payor navigation, claims and billing, registration, insurance referral and authorization processes, and appeals.
• 2 years Experience related to CPT, ICD coding assignment, and medical terminology (Required).
• 2 years Comprehensive medical and insurance terminology as well as working knowledge of medical insurance plans, and managed care plans. (Required)

Responsibilities

• Navigate and address payor COB issues prior to services to ensure proper claims payments and obtain/pre-certifications.
• Provide supporting clinical information to insurance payors to decrease peer-to-peer reviews.
• Work with Payor Nurse Navigators to decrease delays in patients' access to care.
• Review clinical documentation to ensure outcomes support required care and document proven outcomes.
• Establish contact with patients to pre-register for future dates of service.
• Verify insurance eligibility and benefits using real-time tools and payer websites.

Skills

Communication

Customer service

Verbal skills

Interpersonal

Attention to detail

Problem solving

Confidentiality

Insurance knowledge

EMR experience

Education

High School Diploma or GED

Job description

Children's National Hospital is seeking a Payor Clearance Associate within the Revenue Cycle team to ensure payor clearance before services. The role collaborates with physicians, payers, and patients to navigate insurance prior authorizations and optimize access to care.

You will verify eligibility, obtain pre-certifications, register patients, and support denial management while maintaining CNMC confidentiality and high-quality customer service.