Case Manager

Summary

Join STA Personnel Solutions South Africa, a global BPO company, for a remote Case Manager position partnering with a USA-based healthcare client. This role requires a minimum of one year of US healthcare experience, strong knowledge of medical billing and claims, initial authorization processing, and case management. You will manage healthcare accounts, oversee billing processes, review clinicals, and follow up on claims. The position demands proficiency in MS Office and adherence to HIPAA regulations. Successful candidates must have a fixed fibre line internet connection with a minimum speed of 25 Mbps and a reliable power backup solution. This is a remote position for South African citizens only, requiring work during US hours (9 am to 6 pm EST).

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
• A fixed fibre line with a minimum speed of 25 Mbps (upload & download) and the ability to support a wired Ethernet connection is mandatory
• A reliable power backup solution is required to manage load shedding and power outages

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