Payor Clearance Associate

About the role

Kids Are Our Everything. Department 10119 Eligibility and Financial Clearance Pay Range $43,326.40 - $72,196.80 Payor Clearance Associates are members of the Revenue Cycle team dedicated to completing patient access and patient financial workflows related to navigating insurance prior authorization processes for assigned services.

Responsibilities

• Navigate and address any payor COB issues prior to services being rendered to ensure proper claims payments;
• Obtain and ensure all authorizations are on file prior to services being rendered;
• Work collaboratively with assigned department (s)/service(s) of the Children’s National Hospital to ensure all scheduled patients have undergone payor clearance prior to service;
• Pre-register patients, verify insurance eligibility and benefits, obtain pre-certification or referral status, and collect patient responsibility amounts for services provided throughout the health system meeting departmental standards for productivity and quality.
• Obtain authorizations for add-on cases and procedures to ensure proper and timely claims payment;
• Follow-up on all cases to ensure procedures authorized were performed, update authorizations as needed;
• Provide supporting clinical information to insurance payors;
• Interpret insurance verification information to estimate patient financial responsibility amounts for scheduled services and inpatient stays;
• Work as a patient advocate along with legal and other entities to remove any barriers prior to service;
• Review and determine insurance plan benefit information for scheduled services, including co-insurance and deductibles;
• Communicate patient financial responsibility amounts and initiate the point of service (POS) collections process;
• Determine patient liability based on service levels and make necessary recommendations;
• Identify patients requiring payment assistance options and facilitate communication between patients and CNMC Financial Information Center (FIC).
• Review clinical documentation to ensure clinicals provided supports desired outcomes prior to submitting to payer;
• Provide education to providers regarding payer requirements and clinical documentation;
• Obtain authorizations for add-on cases and procedures to ensure proper and timely claims payment;
• Follow-up on all cases to ensure procedures authorized were performed, update authorizations as needed;
• Become a subject matter expert on payer requirements;
• Write appeal letters to payers to obtain payment for services;
• Collaborate with individual departments - Compliance Department, Patient Financial Services, Case Management, and Centers of Excellence to reduce first pass denials.

Qualifications

• High School Diploma or GED;
• 2 years Healthcare experience with payor navigation, claims and billing, healthcare registration, insurance referral and authorization processes, and appeals;
• 2 years Experience related to CPT, ICD coding assignment, and medical terminology;
• 2 years Comprehensive medical and insurance terminology as well as working knowledge of medical insurance plans, and managed care plans;
• Ability to communicate with physicians’ offices, patients and insurance carriers in a professional and courteous manner;
• Superior customer service skills and professional etiquette;
• Strong verbal, interpersonal, and telephone skills;
• Experience in healthcare setting and computer knowledge necessary;
• Attention to detail and ability to multi-task in complex situations;
• Demonstrated ability to solve problems independently or as part of a team;
• Knowledge of and compliance with confidentiality guidelines and CNMC policies and procedures;
• Knowledge of insurance requirements and guidelines for Governmental and non-Governmental carriers;
• Previous experience with EMRs or other related software programs preferred;
• Bilingual Abilities Preferred.

Skills

• Ability to communicate with physicians’ offices, patients and insurance carriers in a professional and courteous manner;
• Superior customer service skills and professional etiquette;
• Strong verbal, interpersonal, and telephone skills;
• Experience in healthcare setting and computer knowledge necessary;
• Attention to detail and ability to multi-task in complex situations;
• Demonstrated ability to solve problems independently or as part of a team;
• Knowledge of and compliance with confidentiality guidelines and CNMC policies and procedures;
• Knowledge of insurance requirements and guidelines for Governmental and non-Governmental carriers;
• Previous experience with EMRs or other related software programs preferred;
• Bilingual Abilities Preferred.

Benefits

• Comprehensive health coverage, including medical, prescription, infertility, and transgender health services;
• Generous paid time off, including vacation accrual from day one, sick leave, holidays, and a personal day;
• Financial wellness support, including a 401(k) plan and healthcare and dependent care spending accounts;
• Employer-paid life, AD&D, and long-term disability coverage, with optional supplemental plans;
• Additional perks, including tuition assistance, fitness resources, employee assistance, commuter benefits, and more.

Pay

$43,326.40 - $72,196.80

Schedule

Not specified