PHRN Clinical Auditor (WFH) UPT

As a PHRN Clinical Auditor at ISTA Solutions, your primary responsibilities include reviewing and processing long-term care authorization requests, auditing clinical records for compliance, and ensuring accurate billing and coding practices. You'll also act as an insurance liaison to resolve discrepancies, maintain compliance with healthcare regulations, and work closely with healthcare providers to ensure documentation is aligned with care plans.

To excel in the PHRN Clinical Auditor role at ISTA Solutions, you must have a current and valid PHRN license, a solid understanding of US Healthcare Insurance operations, and experience with prehospital patient care protocols. Additionally, strong analytical skills, attention to detail, and good verbal and written communication capabilities are essential for success in this position.

Yes! The PHRN Clinical Auditor position at ISTA Solutions is a work-from-home opportunity, allowing you to enjoy the flexibility of remote work while still engaging with a collaborative team dedicated to providing exceptional care.

At ISTA Solutions, we prioritize your growth and career pathway. As a PHRN Clinical Auditor, you will have access to ongoing training, performance appraisals, and opportunities for advancement within the organization. We foster a culture of continuous learning, ensuring that you're always able to expand your skillset and achieve your professional goals.

The PHRN Clinical Auditor position at ISTA Solutions operates on a shifting schedule that includes both weekdays and weekends. We value flexibility and understand the importance of work-life balance, so you can expect a supportive approach to your scheduling needs.

When auditing clinical records, I start by reviewing each document for compliance with established guidelines and standards. I carefully check for missing information, inconsistencies, and ensure that billing and coding align with the services rendered. I also assess the clarity of care plans and communicate findings with relevant stakeholders to rectify any issues.

I approach discrepancies in insurance billing by first gathering all relevant documentation and understanding the nature of the discrepancy. I then communicate with the insurance company, clarifying authorization requirements and seeking resolution. Clear communication and a focus on accuracy are key to addressing these issues effectively.

To ensure compliance, I stay updated on state and federal regulations and industry standards through continuous education and professional development. I implement checklists and regular audits of our processes to identify areas needing improvement, and I encourage team engagement in compliance best practices to maintain high standards.

I balance collaboration with independent work by setting clear priorities and communicating effectively with my team. While I enjoy working alongside colleagues to enhance our processes, I also ensure I allocate focused time for solitary tasks, like analyzing records and preparing reports, to deliver high-quality results.

In my previous roles, I managed long-term care authorizations by reviewing requests meticulously to verify they met all administrative and clinical requirements. My experience includes liaising with various healthcare providers and insurers to smooth out the authorization process and ensure timely approvals.

I chose to work in clinical auditing because I believe in the critical role of maintaining healthcare standards and ensuring patient safety. The opportunity to improve clinical practices while driving efficiency and compliance resonates with my professional values and passion for healthcare.

The biggest challenges in clinical auditing include staying current with ever-changing regulations and navigating complex billing systems. Continuous education and adaptive strategies are essential to effectively manage these challenges while ensuring compliance and accuracy.

I would approach the situation by first verifying the error against the original documentation to ensure accuracy. Once confirmed, I would communicate with the involved healthcare providers to clarify the situation and rectify the documentation promptly to comply with billing and regulatory standards.

In a previous role, I conducted an audit where I identified areas of non-compliance in billing practices that led to delayed reimbursements. By collaborating with the billing team to rectify these practices and implementing new guidelines, we improved the efficiency of our billing processes and significantly reduced errors.

I handle the stress of tight deadlines by prioritizing tasks and staying organized. I break down larger tasks into manageable parts and set specific timeframes for each part. This structure allows me to stay focused, maintain my productivity, and meet deadlines without sacrificing the quality of my work.