Payor Clearance Associate

Job Description

The Payor Clearance Associate supports the patient access and revenue cycle process by ensuring insurance coverage, referrals, and authorization requirements are addressed before patients receive medical services. This role works with patients, insurance companies, healthcare providers, and internal clinical teams to help prevent delays in care and ensure accurate insurance processing.

Earnings

$45,000-55,000 (dependent on experience) salary

Duties

• Verify patient insurance eligibility, benefits, and coverage requirements.
• Review insurance plans to determine whether prior authorization or pre-certification is required for medical services, procedures, medications, or treatments.
• Contact insurance companies to obtain authorization information and confirm coverage requirements.
• Communicate with healthcare providers and internal departments to gather missing information and resolve authorization or coverage issues.
• Maintain accurate patient records, insurance information, and authorization documentation in the appropriate systems.
• Follow up on pending authorizations and outstanding requirements to help prevent delays in patient care.
• Provide professional, timely communication while handling confidential patient and insurance information.
• Work collaboratively with patient access, clinical, and revenue cycle teams to support efficient operations.

Requirements

• Experience in healthcare administration, patient access, insurance verification, prior authorization, or medical billing.
• Knowledge of medical insurance terminology, eligibility requirements, and authorization processes.
• Strong attention to detail, organization, and follow-through.
• Effective verbal and written communication skills.
• Ability to manage multiple requests, meet deadlines, and resolve issues in a fast-paced healthcare environment.
• Basic computer skills and the ability to document information accurately in electronic systems.
• Commitment to patient confidentiality and customer service.

Ideal Candidate

• The ideal candidate has experience working with health insurance companies and healthcare providers to verify benefits, obtain authorizations, or resolve insurance-related issues. Experience with specialty care, radiology, oncology, infusion services, or other procedure-based authorizations may be particularly relevant.