Clinical Case Manager – US Healthcare

🔥 0 minutes ago

🇿🇦 South Africa – Remote

⏰ Full Time

🟢 Junior

👔 Manager

🚫👨‍🎓 No degree required

👻 Ghost score 10%

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iSTA Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

📦 Logistics

📣 Marketing

Healthcare • Logistics • Marketing

iSTA Solutions is your remote healthcare operations partner specializing in off-site staffing solutions. With over 20 years of experience, we focus on enhancing operational efficiency for businesses, particularly in the healthcare sector, by providing customized remote teams that take on tasks ranging from customer service to data entry. Our goal is to support organizations in scaling their operations seamlessly while achieving significant cost savings and improved productivity.

📋 Description

• Manage US healthcare cases end-to-end for clients in Skilled Nursing Facilities, post-acute care, and revenue cycle management • 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 through resolution, including denials, rejections, and appeals • Liaise with Medicare, Medicaid, and commercial payers • Ensure accurate medical billing and coding using ICD-10 and CPT • Maintain compliant case notes and documentation • Collaborate with clinical, administrative, and finance teams • Ensure HIPAA compliance • Use MS Office for reporting and tracking • Manage high volumes of emails accurately and professionally

🎯 Requirements

• Healthcare experience is mandatory; candidates without healthcare experience will not be considered • 1–3 years of healthcare experience • Knowledge of ICD-10 and CPT coding • Proven experience in case or account management • Proven experience in SNFs or post-acute care • Proven experience in inpatient authorization processing • Proven experience in clinical review • Proven experience in medical billing • Fixed fibre line with minimum 25 Mbps upload and download speeds • Ability to support a wired Ethernet connection • Reliable power backup solution for load shedding and power outages • Ability to work USA hours Monday to Friday, 9 am to 6 pm EST • Advantageous: clinical background in Nursing or Allied Health • Advantageous: experience in sub-acute, SNF, hospice, or hospital environments • Advantageous: exposure to US healthcare BPO operations • Advantageous: strong documentation and reporting discipline • Advantageous: experience with US insurance payers

🏖️ Benefits

• Work-from-home arrangement • Compensation for working on all South African public holidays as per BCEA