Payor Clearance Specialist

Payor Clearance Specialist

Location: Silver Spring, Maryland

Compensation: 43,000-60,000

Schedule: Monday through Friday- 8:00-5:00PM

Benefits: This position is eligible for medical, dental, vision, and 401(k).

Job Description

We're hiring a Payor Clearance Associate to join a growing healthcare organization's Revenue Cycle team! This is an excellent opportunity for someone with a strong background in healthcare insurance, prior authorizations, and patient access who enjoys working behind the scenes to help ensure patients receive the care they need without unnecessary insurance-related delays.

In this role, you'll play an important part in coordinating with insurance companies, physician offices, nurses, and internal healthcare teams to secure necessary authorizations, verify insurance coverage, resolve denials, and ensure services are financially cleared before patients receive care.

This is a non-patient-facing, high-volume administrative role that requires strong attention to detail, independent problem-solving, and the ability to manage multiple cases throughout the day.

What You'll Do

• Obtain and secure insurance authorizations, pre-certifications, and referrals for scheduled medical procedures and services.
• Verify patient insurance eligibility, coverage, and benefits using payer portals, eligibility tools, and telephone communication.
• Review insurance requirements to determine whether prior authorizations or referrals are needed before services are rendered.
• Communicate regularly with physician offices, nurses, providers, and internal healthcare departments to obtain missing information and prevent delays in patient care.
• Review clinical documentation to ensure medical records support the requested services and meet insurance medical necessity requirements.
• Submit supporting clinical information to insurance companies to help secure approvals and reduce the need for peer-to-peer reviews.
• Research and resolve authorization issues, insurance denials, and coordination of benefits (COB) discrepancies.
• Prepare and submit appeal letters to insurance companies when services are denied or additional review is required.
• Follow up on pending authorizations, add-on procedures, and outstanding cases to ensure approvals are obtained and updated as needed.
• Review insurance benefits, including deductibles, copays, coinsurance, and in-network versus out-of-network coverage.
• Maintain accurate documentation of insurance verifications, authorization statuses, appeals, and follow-up activities within designated systems.
• Identify trends in denials and authorization issues and collaborate with internal departments to improve processes and reduce reimbursement delays.
• Manage a high-volume workload of approximately 35–40 cases per day while maintaining productivity and accuracy standards.

Why This Role Stands Out

• Opportunity to make a meaningful impact by helping remove insurance-related barriers to patient care.
• Work behind the scenes as an important part of a hospital's Revenue Cycle team.
• Collaborate with a variety of healthcare professionals, including providers, nurses, and insurance representatives.
• Utilize your healthcare insurance and authorization knowledge in a specialized role.
• Opportunity to develop expertise in insurance requirements, medical necessity, denials, and appeals.
• Great fit for someone who enjoys problem-solving, working independently, and taking ownership of their workload.

This Role Is For You If:

• You have a strong understanding of healthcare insurance processes and prior authorization requirements.
• You enjoy researching insurance issues and finding solutions to get services approved.
• You're comfortable communicating with physician offices, nurses, providers, and insurance companies throughout the day.
• You're detail-oriented and understand the importance of accurate insurance documentation and authorization tracking.
• You can manage a high-volume workload while staying organized and meeting productivity expectations.
• You're comfortable navigating multiple computer systems, insurance portals, and electronic medical records.
• You're a self-starter who takes accountability for your work and can independently manage daily responsibilities.
• You have strong verbal communication, professional phone etiquette, and problem-solving skills.
• You enjoy working in a fast-paced healthcare environment where your work directly supports patient access and hospital operations.

Requirements

• High school diploma or GED required.
• Minimum of 2 years of healthcare experience involving payor navigation, claims and billing, healthcare registration, insurance referrals, prior authorizations, or appeals.
• Minimum of 2 years of experience related to CPT and ICD coding assignment and medical terminology.
• Minimum of 2 years of experience with comprehensive medical and insurance terminology.
• Working knowledge of medical insurance plans, managed care plans, and governmental and non-governmental insurance carriers.
• Experience verifying insurance eligibility and benefits and navigating authorization requirements.
• Strong communication, organizational, multitasking, and problem-solving skills.
• Ability to work independently and manage a high-volume workflow.

Preferred Qualifications:

• Experience with EPIC, Cerner, Passport, or other EMR systems.
• Experience navigating insurance payer portals and real-time eligibility verification tools.
• Previous hospital or healthcare revenue cycle experience.
• Experience with insurance denials, appeals, and medical necessity reviews.
• Bilingual abilities are a plus.

Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.