PHRN Clinical Review Team Lead | Hybrid

ISTA Personnel Solutions

7d•Hybrid

About The Position

ISTA Solutions, an outsourcing/offshoring company, is in search of an experienced PHRN Team Lead 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!

Requirements

Must have an active Philippine Registered Nurse (PHRN) license.
With 2+ years clinical nursing experience
At least 1 year of team lead / supervisory experience
Familiarity with ICD-10 diagnosis codes.
Strong knowledge of insurance verification, prior authorizations, and EMR systems (KanTime).
Experience reviewing or matching clinical documentation, treatments, and care plans
High level of attention to detail and analytical skills.
Proficient in Microsoft tools and web-based forms.
Good verbal and written English skills
Must be able to report onsite in Shaw Blvd, Mandaluyong
Amenable working night shifts

Responsibilities

Oversees daily operations for all agents delivering high-quality and valued services
Conduct training and coaching, including insights and action plans to improve
Analyze and report on productivity and other metrics - such as attendance, end-of-day reports, and compliance with company protocols
Ensure that the client is updated on significant program activities, issues, and concerns through calls, emails, meetings, reports
Perform other supervisory tasks as required
Review and audit patient charts and clinical documentation.
Verify that ICD-10 diagnosis codes appropriately correspond with documented treatments and services.
Evaluate patient care plans to ensure alignment with diagnoses, prescribed treatments, and documented services.
Complete structured audit reports consisting of 140+ audit questions for each patient chart.
Ensure chart reviews are conducted with a high level of accuracy, consistency, and adherence to documentation standards.
Maintain productivity targets by completing patient chart audits within an average timeframe of approximately 30 minutes per chart.
Identify discrepancies, inconsistencies, or documentation gaps and flag them appropriately through the reporting process.
Follow established workflows, auditing procedures, and quality standards for chart review activities.