Case Manager & Billing (USA Healthcare) - EST hours (Remote)

ISTA Personnel Solutions; Gauteng; Remote; ZAR 200 000 - 300 000; Full time

Job summary

A global BPO company is seeking a Healthcare Case Manager & Billing Lead with USA experience to manage healthcare accounts and ensure accurate billing processes. The ideal candidate should have at least 1 year of experience in the US healthcare sector, strong skills in medical billing, coding, and case management. This role is fully remote, working USA hours with strict requirements for internet speed and power backup.

Qualifications

• Minimum of 1 year of experience in US healthcare settings focused on medical billing and case management.
• Highly detail-oriented with strong analytical skills.
• Efficient in managing and prioritizing emails.

Responsibilities

• Manage healthcare accounts ensuring seamless claims processing and authorizations.
• Oversee accurate and timely medical billing processes.
• Review clinicals for case management and coordinate approvals.

Skills

Medical billing

Case management

Coding (CPT, ICD-10)

HIPAA regulations

Analytical skills

Communication

Problem-solving

Organizational abilities

Tools

MS Office (Excel, PDF, Outlook)

Job description

Overview

I STA 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 Healthcare Case Manager & Billing Lead with USA 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).
• 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

• 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.