Clinical Case Manager

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

Job summary

A global BPO company is seeking a detail-oriented Clinical Case Manager. This remote role involves managing complex healthcare cases, coordinating with US insurance providers, and ensuring compliant billing. Candidates must have healthcare experience and the ability to work USA hours from South Africa. Key responsibilities include medical documentation review, authorization processing, and maintaining HIPAA compliance. Applicants must have a minimum of 1-3 years of relevant experience and knowledge of ICD-10 coding.

Benefits

Remote working

Compensated for South African public holidays

Qualifications

• 1–3 years healthcare experience required.
• Proven experience in case or account management.
• Experience with inpatient authorization processing.

Responsibilities

• Manage end-to-end case management for US healthcare clients.
• Process inpatient and SNF authorizations.
• Ensure accurate medical billing and coding.

Skills

Knowledge of ICD-10 and CPT coding

Healthcare experience

Case management

Medical billing

Tools

MS Office

Job description

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.

Clinical Case Manager

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 (4:00 PM to 1:00 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.