ISTA Personnel Solutions South Africa - we are a global BPO company, partnering with a USA-based client offering Billing and Accounts Receivable Management Services in the Healthcare Sector, and are seeking a Case Manager with Skilled Nursing Facilities experience.
This role requires a minimum of 1-year experience in the USA Healthcare Industry, with strong knowledge of medical billing (claims), initial authorization processing (In-patient) and case management (reviewing clinicals) and MS Office.
**** PLEASE DO NOT APPLY IF YOU DO NOT HAVE HEALTHCARE EXPERIENCE - YOU WILL NOT BE CONSIDERED!! ****
PLEASE NOTE:
- Working Hours: This role requires you to work USA hours Mon - Fri from 9am to 6pm EST (15h00pm to midnight South African time, however these hours are subject to change depending on daylight savings).
- Work Environment: This is a remote role for South African Citizens only.
- Internet Requirements: A fixed fibre line with a minimum speed of 25 Mbps (upload & download) and the ability to support a wired Ethernet connection is mandatory. Applicants without a fixed fibre line cannot be considered.
- Power Backup: A reliable power backup solution is required to manage load shedding and power outages. Applicants without a power backup cannot be considered.
Key Responsibilities:
- Manage healthcare accounts, ensuring seamless claims processing and authorizations.
- Oversee accurate and timely medical billing processes, including coding for services
- Review clinicals for case management and coordinate approvals.
- Follow up on claims, resolve denials, and liaise with insurance providers.
- Work closely with clinical, administrative, and financial teams to support seamless patient care and billing processes.
- Utilize MS Office (Excel, PDF, Outlook) for reporting and documentation.
- Ensure compliance with billing policies and healthcare regulations.
Requirements
- Minimum of 1 year of experience in US healthcare settings, with a strong focus on medical billing, coding (CPT, ICD-10), and case management.
- Sound knowledge of HIPAA regulations.
- Strong analytical skills and good judgment
- Highly detail-oriented and precise
- Efficient in managing and prioritizing emails
- Excellent communication, problem-solving, and organizational abilities
- Follows established processes with accuracy
- Understands processes with the ability to exercise good judgement in taking appropriate next steps
If you are not contacted within 14 working days, please consider your application unsuccessful.
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