About the job
Join ISTA Solutions as a Prior Authorization Registered Nurse (PHRN) and be part of a dynamic and rapidly growing team!
At ISTA Solutions, an outsourcing and offshoring company, we value our employees, offering a culture that emphasizes satisfaction and work-life balance. As a member of our team, you will collaborate with skilled professionals dedicated to long-term success and continuous learning. We are seeking a dedicated team player ready to contribute to our mission.
Key Responsibilities:
- Review claims requiring Prior Authorization.
- Utilize the CMM key to complete necessary clinical questionnaires.
- Extract clinical information from PCC (PointClickCare) to support Prior Authorization submissions.
- Submit accurate Prior Authorization requests to health plans as needed.
- Maintain precise documentation of all actions taken within required systems.
- Ensure compliance with payer guidelines, company policies, and regulatory standards.
- Meet productivity and turnaround time goals.