Offer summary

Qualifications:

Current and valid PHRN license, Good working knowledge of US Healthcare Insurance, Strong knowledge of prehospital patient care protocols and regulatory requirements, Excellent attention to detail and analytical skills..

Key responsabilities:

Review and process authorization requests for long-term care services

Audit clinical records and documentation for compliance and accuracy

Communicate with insurance companies to resolve billing discrepancies

Collaborate with healthcare teams to ensure proper documentation and care plans.

Job description

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.

Requirements

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)

Benefits

What can we offer you?