Clinical Auditor

Summary

Join ISTA Solutions, a growing outsourcing company, as an experienced Clinical Auditor. You will work with a skilled team focused on employee satisfaction and work-life balance. Responsibilities include reviewing and processing long-term care authorizations, ensuring billing accuracy, liaising with insurance companies, conducting clinical audits, collaborating with healthcare providers, and maintaining regulatory compliance. The ideal candidate possesses a current PHRN license, strong healthcare insurance knowledge, and excellent analytical and communication skills. ISTA Solutions offers competitive salary and benefits, including health insurance, paid time off, and opportunities for professional growth.

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)

Responsibilities

• Review and process authorization requests for long-term care services, ensuring compliance with policies, guidelines, and payer requirements
• Review billing records for accuracy, including coding for services rendered, ensuring that all claims are properly submitted and follow-up is done for reimbursement
• Communicate with insurance companies to clarify authorization requirements, resolve billing discrepancies, and ensure timely approvals for long-term care services
• 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 teams, administrators, and other stakeholders to ensure appropriate documentation and care plans are in place for authorization approval and billing accuracy
• Ensure that all authorizations, billing practices, and insurance communications comply with state and federal regulations, as well as industry standards

Benefits

• 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