PHRN Clinical Auditor (WFH) UPT

ISTA Solutions, an outsourcing/offshoring company, is in search of an experienced Clinical Auditor to join our rapidly expanding team. As a member of our team, you will have the opportunity to work with highly skilled professionals, who prioritize employee satisfaction and work-life balance. At ISTA Solutions, we pride ourselves on creating a culture focused on long-term success and life-long learning. We're looking for a team player who is ready to contribute to our mission, just like you!

Account specific roles and responsibilities:

• Long Term Care Authorizations: Review and process authorization requests for long-term care services, ensuring compliance with policies, guidelines, and payer requirements.
• Billing and Coding: Review billing records for accuracy, including coding for services rendered, ensuring that all claims are properly submitted and follow-up is done for reimbursement.
• Insurance Liaison: Communicate with insurance companies to clarify authorization requirements, resolve billing discrepancies, and ensure timely approvals for long-term care services.
• Clinical Review & Auditing: Audit clinical records and documentation to ensure they meet the standards for authorization and billing, identifying any gaps or discrepancies in documentation or services rendered.
• Collaborate with Healthcare Providers: Work closely with healthcare teams, administrators, and other stakeholders to ensure appropriate documentation and care plans are in place for authorization approval and billing accuracy.
• Compliance & Regulatory Adherence: Ensure that all authorizations, billing practices, and insurance communications comply with state and federal regulations, as well as industry standards.

• Current and valid PHRN license
• Good working knowledge with US Healthcare Insurance

• Strong knowledge of prehospital patient care protocols, standards, and regulatory requirements.
• Excellent attention to detail and analytical skills.
• Good verbal and written English skills
• Ability to work independently and collaboratively in a team-oriented environment.
• Commitment to continuous learning and professional development.
• Must be residing within GMA (Greater Manila Area)
• Willing to work on shifting schedule (weekdays and weekends)

What can we offer you?

• Competitive salary and benefits
• Health Insurance with free dependents*
• 10%-night differential
• Attendance Bonus
• Paid time off
• Convertible to cash leave credits
• Performance Appraisal
• Work-life balance
• A focus on growing your career path with us
• We encourage you to follow your passions and learn new skills

Our commitment to you

• Strong culture and values-driven leadership
• We create opportunities for you to learn and grow at any stage of your career
• Continuous learning and innovation
• We foster an all inclusive environment where everyone thrives