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

Position Overview

• Location Type: Remote
• Job Type: Full-time
• Salary: Not specified

ISTA Personnel Solutions South Africa, a global BPO company, is partnering with a USA-based client in the Healthcare Sector. We are seeking a Healthcare Case Manager & Billing Lead with USA experience. This role requires a minimum of 1 year of experience in the USA Healthcare Industry, with strong knowledge of medical billing (claims), initial authorization processing (In-patient), and case management (reviewing clinicals), as well as MS Office proficiency.

PLEASE DO NOT APPLY IF YOU DO NOT HAVE HEALTHCARE EXPERIENCE - YOU WILL NOT BE CONSIDERED!!

Working Hours: This role requires you to work USA hours, Monday - Friday, from 9 am to 6 pm EST (3:00 pm to midnight South African time). These hours are subject to change depending on daylight savings.

Work Environment: This is a remote role for South African Citizens only.

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 accuracy.
• Understands processes with the ability to exercise good judgment in taking appropriate next steps.

Additional Details

• Employment Type: Full-time
• Workplace: Remote
• Language: English
• Department: SA - Operations
• Published: 2025-06-06

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