Virtual Healthcare Case Coordinator (Skilled Nursing) - EST hours (Remote)

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

Job summary

A leading global BPO provider in South Africa is seeking a Virtual Healthcare Case Coordinator. The successful candidate will manage medical billing and claims related to Skilled Nursing Facilities while collaborating with a US client. This fully remote role requires healthcare experience and familiarity with HIPAA compliance. The position involves ensuring compliance, investigating claims denials, and working with MS Office Suite. Strong analytical and communication skills are essential for success in this role.

Qualifications

• Healthcare experience required, preferably in billing, claims, authorizations, or case management.
• Familiarity with medical coding standards and HIPAA compliance is essential.
• Strong analytical and organizational skills to handle multiple tasks.

Responsibilities

• Manage patient accounts including claims processing.
• Oversee submission of medical claims and coding.
• Investigate claims denials with insurance providers.

Skills

Healthcare experience

Exposure to USA healthcare systems

Analytical skills

Problem-solving skills

Organizational skills

Attention to detail

Written communication skills

Verbal communication skills

Tools

MS Office Suite

Job description

Overview

STA Personnel Solutions South Africa - We are a global Business Process Outsourcing (BPO) provider based in South Africa, working with a US-based client in the healthcare revenue cycle management space. We are currently looking for a Virtual Healthcare Case Coordinator with experience in Skilled Nursing Facilities (SNFs) to join our team.

Role Overview

The successful candidate will be responsible for managing medical billing, initial authorizations, and case management activities related to Skilled Nursing Facilities. You will work remotely and collaborate with our US client during EST hours.

Working Details

• Working Hours: This role requires you to work USA hours Mon - Fri from 9am to 6pm EST (15h00– midnight South African time; hours subject to change with daylight saving).
• Work Environment: This is a fully remote role.
• Internet Requirements: A fixed fibre line with minimum speed 25 Mbps (upload & download) and 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 power backup cannot be considered.

Key Responsibilities

• Manage patient accounts, including claims processing and authorization tracking.
• Oversee the accurate and timely submission of medical claims, including appropriate coding.
• Review clinical documentation to support authorization and care coordination.
• Investigate and resolve claim denials in collaboration with insurance providers.
• Work alongside clinical, billing, and administrative teams to ensure continuity in patient care and revenue cycle processes.
• Use MS Office (Outlook, Excel, PDF) to manage documentation and communications.
• Ensure compliance with relevant healthcare and data protection regulations (e.g. HIPAA).

Qualifications

• Healthcare experience required, preferably with exposure to USA healthcare systems, especially in medical billing, claims, authorizations, and/or case management in SNFs or similar environments.
• Familiarity with medical coding standards (CPT, ICD-10) and HIPAA compliance.
• Strong analytical, problem-solving, and organizational skills.
• High attention to detail and accuracy in documentation and data handling.
• Proficient in MS Office Suite, especially Excel and Outlook.
• Ability to prioritize work, manage high email volumes, and follow established processes.
• Strong written and verbal communication skills.

If you are not contacted within 14 working days, please consider your application unsuccessful.