Offer summary

Qualifications:

Minimum of 1 year of experience in the USA healthcare industry., Strong knowledge of medical billing, coding (CPT, ICD-10), and case management., Familiarity with HIPAA regulations and MS Office (Excel, PDF, Outlook)., Strong analytical skills, attention to detail, and excellent communication abilities..

Key responsabilities:

Manage healthcare accounts and ensure seamless claims processing and authorizations.

Oversee accurate and timely medical billing processes, including coding for services.

Review clinicals for case management and coordinate approvals with insurance providers.

Collaborate with clinical, administrative, and financial teams to support patient care and billing processes.

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 Healthcare Case Manager & Billing Lead.

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 USA 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 (16h00pm to 01h00am South African time. These working 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 judgement in taking appropriate next steps

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

Required profile