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Clinical Case Manager (US Healthcare) - EST hours (Remote)

ISTA Personnel Solutions
5 days ago
Full-time
Remote
South Africa
Web Development

About ISTA Personnel Solutions

ISTA Personnel Solutions is a dynamic and fast-growing BPO company. We are not a recruitment agency. We partner with international U.S. clients and integrate our staff members directly within our clients’ operations. We focus on long-term placements where you become an integral part of the client’s team.

We are seeking a Clinical Case Manager with healthcare experience in SNFs, inpatient authorizations, clinical review, and medical billing.

Role Summary and Responsibilities

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***

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

Desired Experience & Requirements

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

Work Schedule & Remote Working Requirements

  • 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).

Important Information