Job Title: Payor Clearance Specialist (Authorizations)
Location: Silver Spring, MD (Onsite) 20904
Industry: Healthcare / Revenue Cycle Management
Pay: $23.00 - $27.00 / Per Hour
Benefits: This position is eligible for medical, dental, vision, life insurance and retirement benefits.
About Our Client
Addison Group is partnering with a nationally recognized pediatric healthcare organization seeking experienced Payor Clearance Specialists to join its centralized Patient Access team. This position is ideal for candidates with strong insurance verification, prior authorization, payer navigation, and revenue cycle experience who enjoy working complex cases and collaborating with insurance carriers to ensure patients receive timely access to care.
Job Description
The Payor Clearance Specialist is responsible for completing patient access workflows related to insurance payer requirements, including insurance verification, authorizations, referrals, appeals, and denial resolution. This role works closely with insurance carriers, provider offices, nurses, and internal departments to remove barriers to care, improve reimbursement outcomes, and ensure patients are financially cleared prior to services being rendered.
Key Responsibilities
- Verify insurance eligibility, benefits, and coverage using payer portals, eligibility tools, and insurance carrier resources.
- Obtain prior authorizations, referrals, and pre-certifications for scheduled services.
- Navigate coordination of benefits (COB) issues to ensure accurate claims processing and reimbursement.
- Review CPT and ICD coding requirements to support authorization and medical necessity reviews.
- Communicate with insurance carriers, physician offices, and care teams regarding authorization status and payer requirements.
- Submit clinical documentation and supporting information to payers to secure approvals and reduce denials.
- Complete patient pre-registration and financial clearance activities prior to scheduled services.
- Review and resolve authorization-related denials and identify appeal opportunities.
- Prepare appeals and supporting documentation for payer reconsideration and reimbursement.
- Maintain accurate documentation of payer communications, authorization activity, and account updates.
- Collaborate with revenue cycle, compliance, case management, and clinical departments to improve financial outcomes.
Requirements:
- 3+ years of healthcare experience involving insurance verification, authorizations, referrals, claims, billing, appeals, or payer navigation.
- 2+ years of CPT and ICD coding experience required.
- Strong experience with insurance eligibility verification, prior authorizations, and referral management.
- Experience working directly with commercial and government insurance carriers.
- Knowledge of claims processing, denials, appeals, coordination of benefits (COB), and medical necessity requirements.
- Strong understanding of medical terminology, payer regulations, and healthcare revenue cycle processes.
- Ability to manage high-volume workflows while maintaining accuracy and attention to detail.
- Excellent communication, customer service, multitasking, and problem-solving skills.
- High School Diploma or GED required.
Additional Details
- Schedule: Monday-Friday, shifts between 8:00 AM and 6:00 PM based on department needs.
- Work Model: Fully onsite.
- Environment: Centralized Patient Access / Payor Clearance Team.
- Location: Silver Spring, MD 20904
- Parking: Free onsite parking available.
- Productivity: Manage approximately 25-35 complex authorizations, verifications, and payer-related cases per day.
- Systems: Cerner, Passport, payer portals, eligibility verification tools, EMR systems, and future Epic environment.
- Start Date: Mid-November.
- Interview Process: Client review, application, customer service typing test, insurance assessment, onsite interview, offer, and background check.
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.
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