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
Average salary estimate
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