ISTA Personnel Solutions South Africa is a global BPO partnering with a USA-based healthcare client providing services within Skilled Nursing Facilities (SNFs), post-acute care, and revenue cycle management.
We are seeking a Clinical Case Manager with healthcare experience in SNFs, inpatient authorizations, clinical review, and medical billing. This remote role requires a detail-oriented professional who can manage complex healthcare cases, coordinate with US insurance providers, and ensure compliant billing and authorization outcomes.
Important: ***Applicants must have healthcare experience — candidates without it will not be considered***
PLEASE NOTE:
- Working Hours: This role requires you to work USA hours Mon - Fri from 9 am to 6 pm EST (3:00 PM to 00:00 AM South African time); however, these hours are subject to change depending on daylight savings.
- 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.
- Work Environment: This is a fully remote working role.
- Public Holidays: You will be required to work on all South African public holidays (compensated as per BCEA).
Key Responsibilities:
- End-to-end case management for US healthcare clients
- Review clinical documentation for medical necessity and level of care
- Process inpatient and 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
Requirements:
- Knowledge of ICD-10 and CPT coding
- 1–3 years healthcare experience
- Proven experience in:
- Case or account management
- SNFs or post-acute care
- Inpatient authorization processing
- Clinical review
- Medical billing
Advantageous:
- 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
If you are not contacted within 14 working days, please consider your application unsuccessful.