ISTA Personnel Solutions South Africa is hiring a Clinical Case Manager to manage complex US healthcare cases for a BPO's healthcare client. This remote role requires working Eastern Standard Time (EST) hours and is responsible for end-to-end case management, clinical review, authorizations, and medical billing coordination with US insurance providers.
What You'll Do
- Manage end-to-end case management for US healthcare clients
- Review clinical documentation for medical necessity and level of care
- Process inpatient and Skilled Nursing Facility (SNF) authorizations
- Coordinate authorizations and claims with providers, payers, and patients
- Manage US healthcare claims from submission to resolution, including denials, rejections, and appeals
- Liaise with Medicare, Medicaid, and commercial payers
- Ensure accurate medical billing and coding (ICD-10, CPT)
- Maintain compliant case notes and documentation
- Collaborate with clinical, administrative, and finance teams
- Ensure HIPAA (US) compliance
- Utilize MS Office for reporting and tracking
- Manage high volumes of emails with accuracy and professionalism
What We're Looking For
- Knowledge of ICD-10 and CPT coding
- 1–3 years of healthcare experience
- Proven experience in case or account management
- Proven experience in Skilled Nursing Facilities (SNFs) or post-acute care
- Proven experience in inpatient authorization processing
- Proven experience in clinical review
- Proven experience in medical billing
Nice to Have
- Clinical background (Nursing or Allied Health)
- Experience in sub-acute, SNF, hospice, or hospital environments
- Exposure to US healthcare BPO operations
- Strong documentation and reporting discipline
- Experience with US insurance payers
Technical Stack
- MS Office
Team & Environment
You will collaborate with clinical, administrative, and finance teams.
Work Mode
This is a remote position operating on Eastern Standard Time (EST) hours.
ISTA Personnel Solutions South Africa is an equal opportunity employer.
