Payor Clearance Specialist (Authorizations)

About the role

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.

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.

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.

Benefits

This position is eligible for medical, dental, vision, life insurance and retirement benefits.

Pay

$23.00 - $27.00 per hour

Schedule

Monday–Friday, shifts between 8:00 AM and 6:00 PM based on department needs.

Additional details

• 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