Medicaid Recertification Specialist (US Healthcare) - Remote (EST Hours)

ISTA Personnel Solutions is a dynamic, fast-growing BPO company. We are not a recruitment agency — we operate as a dedicated extension of our clients’ teams, delivering high-quality service with precision, efficiency, and a personal touch.

We are seeking a highly detail-driven Medicaid Recertification Specialist to manage the full Medicaid recertification process for residents within supported healthcare facilities. This role requires strong knowledge of Medicaid documentation standards, compliance requirements, and strict deadline management within a US healthcare environment.

You will be working alongside a team that delivers administrative, financial, and operational support to nursing homes and long-term care facilities across the United States, ensuring full Medicaid compliance and continuity of resident funding.

PLEASE NOTE

• Working Hours: Monday – Friday | 8:00 AM – 5:00 PM EST (2:00 PM – 11:00 PM South African time – subject to daylight savings).
• Public Holidays: This role requires working on both South African and U.S. public holidays (compensation for SA public holidays in accordance with the BCEA).
• Internet Requirements: A fixed fibre line with a minimum speed of 25 Mbps (upload & download) and wired Ethernet capability is mandatory. Applicants without a fixed fibre line cannot be considered.
• Power Backup: Reliable backup required to manage load shedding or outages. Applicants without a power backup cannot be considered.
• Work Environment: Fully remote.

Key Responsibilities

• Manage the full Medicaid recertification process, including tracking timelines and submission deadlines
• Review resident files to ensure all documentation meets Medicaid compliance standards
• Coordinate with facility staff to obtain required documentation and outstanding information
• Prepare and submit recertification documentation accurately and timeously
• Communicate with state Medicaid agencies and facility billing departments where required
• Maintain accurate and up-to-date records within internal systems
• Identify documentation gaps and proactively resolve compliance issues
• Ensure recertifications are completed before eligibility expiration to prevent funding disruptions
• Provide additional administrative and operational support to facilities as needed

Requirements:

• Minimum 2+ years’ experience working with medical aid processes within a healthcare, hospital, or long-term care environment
• Familiarity with U.S. Medicaid and Medicare processes, eligibility requirements, and compliance documentation is highly beneficial
• Experience handling high-volume case files or time-sensitive administrative processes
• Strong understanding of compliance-driven environments and regulatory documentation standards
• Highly detail-oriented with the ability to manage strict deadlines and multiple resident files simultaneously
• Experience working with nursing homes, skilled nursing facilities, or long-term care facilities (advantageous)
• Comfortable working within digital systems and maintaining accurate electronic records
• Proficient in MS Office and Outlook
• Excellent written and verbal English communication skills

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