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PHRN Clinical Auditor (WFH) UPT
Posted 6 days agoViewed
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.
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.
- 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.
- Ensure that all authorizations, billing practices, and insurance communications comply with state and federal regulations, as well as industry standards.
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