Clinical Case Manager (US Healthcare) - EST hours (Remote)

1 week, 1 day ago
Full-time
Junior
Operations
ISTA Solutions

ISTA Solutions

ISTA Solutions is a one-stop outsourcing company that provides quality and cost-efficient services and solutions. They offer tailor-made workflow solutions, skilled agents dedicated to clients, global resources for comprehensive support, and a focus on...

Professional Services
251-1K
Founded 2015

Description

  • Manage end-to-end case handling for US healthcare clients.
  • Review clinical documentation to assess medical necessity and level of care.
  • Process inpatient and skilled nursing facility authorizations.
  • Coordinate authorizations and claims with providers, payers, and patients.
  • Manage healthcare claims from submission through denial, rejection, and appeal resolution.
  • Liaise with Medicare, Medicaid, and commercial insurance payers.
  • Ensure accurate medical billing and coding practices using ICD-10 and CPT.
  • Maintain compliant case notes and documentation in line with HIPAA requirements.
  • Collaborate with clinical, administrative, and finance teams to support case outcomes.
  • Use MS Office to produce reports, track cases, and manage high-volume email communication.

Requirements

  • 1–3 years of healthcare experience.
  • Experience in case or account management.
  • Experience with skilled nursing facilities or post-acute care.
  • Experience processing inpatient authorizations.
  • Experience with clinical review.
  • Experience in medical billing.
  • Knowledge of ICD-10 and CPT coding.
  • Clinical background in Nursing or Allied Health is advantageous.
  • Experience in sub-acute, SNF, hospice, or hospital environments is advantageous.
  • Exposure to US healthcare BPO operations and US insurance payers is advantageous.
  • Must be available to work USA hours Monday to Friday, 9:00 AM to 6:00 PM EST.
  • Must have a fixed fibre internet line with a minimum speed of 25 Mbps upload and download and support for a wired Ethernet connection.
  • Must have a reliable power backup solution.
  • Must be able to work on South African public holidays, with compensation per BCEA.

Benefits

  • Fully remote work arrangement.
  • Work aligned to USA business hours.
  • Compensation for working on South African public holidays as per BCEA.
  • Opportunity to work with a USA-based healthcare client.
  • Exposure to skilled nursing, post-acute care, and revenue cycle management operations.

Interested in this position?

Apply directly on the company website

Apply Now

Similar Roles

Senior Transportation Specialist

ShipBob 251-1K Air Freight & Logistics

ShipBob is hiring a remote Australia-based Senior Transportation Specialist to coordinate carrier, final mile, and freight operations, ensuring reliable execution and timely issue resolution across assigned sites.

Power BI
39 minutes ago

Expression of Interest - Marine Cooks

DOF 1K-5K Gas Utilities

DOF is seeking experienced Marine Cooks to work offshore on its vessels in Australian waters, preparing meals and supporting safe, efficient operations for crew and clients.

1 hour, 36 minutes ago

Assistant Property Manager

Pavago IT Services

Assistant Property Manager for a remote property management team, supporting day-to-day tenant, leasing, maintenance, and reporting operations to keep properties organized, compliant, and running smoothly.

2 hours, 25 minutes ago

Provider Experience Associate

Modern Health 251-1K Health Care Providers & Services

Modern Health is hiring a remote Provider Experience team member to support providers, improve internal support operations, and help scale an exceptional provider experience for its mental health benefits platform.

CRM JIRA Salesforce
2 hours, 50 minutes ago

You're on a roll! Sign up now to keep applying.

Sign Up

Already have an account? Log in

Used by 14,729+ remote workers