Case Manager (Skilled Nursing Facilities) – EST hours (Remote)

ISTA Personnel Solutions; South Africa; Remote; ZAR 300 000 - 400 000; Full time

Job summary

A global BPO company is seeking a Case Manager with skilled nursing facilities experience for a remote role in South Africa. The ideal candidate must have at least 1 year of experience in the US healthcare sector, excelling in medical billing and case management. Strong analytical and communication skills are necessary. The role involves managing healthcare accounts, ensuring accurate claims processing, and collaborating with clinical teams to support patient care.

Qualifications

• Minimum of 1 year of experience in US healthcare settings with focus on medical billing.
• Sound knowledge of HIPAA regulations.
• Highly detail-oriented and precise.

Responsibilities

• Manage healthcare accounts ensuring seamless claims processing.
• Oversee accurate medical billing processes including coding for services.
• Work closely with healthcare teams to support patient care and billing.

Skills

Medical billing knowledge

Case management experience

Analytical skills

Organizational abilities

Communication skills

Tools

MS Office (Excel, PDF, Outlook)

Job description

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 working role
• 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 accuracyUnderstands 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.