Payor Clearance Associate

•Prior Authorization & Insurance Verification (Silver Spring, MD)

Location:

Silver Spring, Maryland Employment Type:

Full-Time, Regular Shift:

Day shift, Monday-Friday, 8:30 a.m.

•5:00 p.m.

Department:

Patient Access / Revenue Cycle

•

Finance Category:

Non-Clinical Professional Salary Range:

$45,000

•$55,000 Job Summary The Payor Clearance Associate is a key member of the Patient Access team, responsible for completing patient access workflows and navigating insurance prior authorization processes for assigned services. In this role, you will help patients enter the care continuum faster by reducing payor-related barriers and improving financial outcomes for scheduled services. Payor Clearance Associates work directly with referring physician offices, insurance payers, and patients to secure full payor clearance before care is provided. This is an excellent opportunity for professionals with experience in prior authorization, insurance verification, medical billing, healthcare registration, or revenue cycle operations. Key Responsibilities

•Pre-Service Payor Clearance Navigate and resolve coordination of benefits (COB) issues before services are rendered to ensure accurate claims payment. Obtain and confirm that all insurance authorizations are on file prior to the date of service. Partner with assigned departments and service lines to ensure every scheduled patient has completed payor clearance before care. Pre-register patients, verify insurance eligibility and benefits, obtain pre-certification or referral status, and collect patient responsibility amounts, meeting departmental productivity and quality standards. Secure authorizations for add-on cases and procedures to support timely, accurate claims payment; follow up on all cases to confirm authorized procedures were performed and update authorizations as needed. Provide supporting clinical information to insurance payors to reduce the need for peer-to-peer review. Collaborate with Payor Nurse Navigators to eliminate delays in patient access to care. Review clinical documentation to confirm it supports the desired authorization outcome before submission to the payor, and document measurable reductions in peer-to-peer trends. Contact patients via inbound and outbound calls to pre-register them for upcoming dates of service. Verify insurance eligibility and benefits using real-time eligibility tools, payer websites, and direct calls to payers; document payer verification responses in the designated registration fields. Validate insurance referral status and coordinate with primary care physician (PCP) offices to obtain referrals. Patient Navigation and Financial Notification Interpret insurance verification data to estimate patient financial responsibility for scheduled services and inpatient stays. Act as a liaison to resolve custodial and documentation issues prior to the patient's arrival. Serve as a patient advocate, working with legal and other partners to remove barriers to care. Review insurance plan benefits for scheduled services, including co-insurance and deductibles, and clearly communicate in-network versus out-of-network coverage. Communicate patient financial responsibility and initiate the point-of-service (POS) collections process; determine patient liability based on service levels and make appropriate recommendations. Identify patients who need payment assistance and connect them with the organization's financial information and assistance resources. QualificationsMinimum Education High School Diploma or GED (required) Minimum Work Experience 2 years of healthcare experience in payor navigation, claims and billing, healthcare registration, or insurance referral and authorization processes (required) 2 years of experience applying medical and insurance terminology, with working knowledge of medical insurance plans and managed care plans (required) Required Skills and Knowledge Ability to communicate professionally and courteously with physician offices, patients, and insurance carriers. Superior customer service skills and professional etiquette. Strong verbal, interpersonal, and telephone communication skills. Prior experience in a healthcare setting with solid computer proficiency. Strong attention to detail and the ability to multitask in complex situations. Proven ability to solve problems independently and as part of a team. Knowledge of and adherence to patient confidentiality guidelines and organizational policies and procedures. Knowledge of insurance requirements and guidelines for governmental and non-governmental carriers. Experience with Cerner, Experian, or comparable patient access software and electronic medical records (EMR) systems preferred. Bilingual abilities preferred. Successful completion of all Patient Access training assessments required. Organizational Commitment Anticipate and respond to customer needs, following up until those needs are met. Teamwork and Communication Demonstrate collaborative and respectful behavior. Partner with all team members to achieve shared goals. Remain receptive to the ideas and opinions of others. Performance Improvement and Problem-Solving Contribute to a positive work environment. Demonstrate flexibility and a willingness to adapt. Identify opportunities to improve clinical and administrative processes. Make sound, well-reasoned decisions. Cost Management and Financial Responsibility Use resources efficiently and look for more cost-effective ways of working. Safety Speak up when team members appear to exhibit unsafe behavior or performance. Continuously validate and verify information needed for decision-making and documentation. Pause in the face of uncertainty and take the time to resolve the situation. Communicate accurately, clearly, and promptly in both verbal and written form. Actively promote safety for patients, families, visitors, and coworkers. Attend carefully to important details, practicing Stop, Think, Act, and Review to self-check behavior and performance. Equal Opportunity Employer We are an equal opportunity employer and evaluate all qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender identity, or any other characteristic protected by law. It is our policy to maintain a drug-free work environment: a workplace free from the illegal use, possession, or distribution of controlled substances (as defined in the Controlled Substances Act), or the misuse of legal substances, by all staff, including management, employees, and contractors. Although recreational and medical marijuana are legal in some jurisdictions, we maintain the right, in accordance with our policy, to enforce a drug-free workplace, including prohibiting recreational or prescribed marijuana.

Pay:

$45,000.00

•$55,000.00 per year

Benefits:

Dental insurance Health insurance Paid time off Vision insurance

Work Location:

In person