Healthcare Case Manager, Account Manager

Summary

Join I STA Personnel Solutions South Africa, a global BPO company, and work remotely as a Healthcare Case Manager/Account Manager. This role requires a minimum of one year of US healthcare account management experience, strong knowledge of medical billing, authorization processing, and case management, and proficiency in MS Office. You will manage healthcare accounts, review clinicals, follow up on claims, and ensure compliance with billing policies and regulations. The position demands working US hours (9 am to 6 pm EST), a fixed fibre line internet connection with a minimum speed of 25 Mbps, and a reliable power backup solution. Only South African citizens are eligible to apply. If you are not contacted within 14 working days, please consider your application unsuccessful.

Requirements

• Minimum of 1-year experience in Account Management in the USA Healthcare Industry
• Strong knowledge of medical billing (claims), initial authorization processing (In-patient) and case management (reviewing clinicals)
• Proficiency in MS Office
• Working US hours Mon - Fri from 9am to 6pm EST (16h00pm to 01h00am South African time)
• A fixed fibre line with a minimum speed of 25 Mbps (upload & download) and the ability to support a wired Ethernet connection
• A reliable power backup solution
• South African Citizen

Responsibilities

• Manage healthcare accounts, ensuring seamless claims processing and authorizations
• Review clinicals for case management and coordinate approvals
• Follow up on claims, resolve denials, and liaise with insurance providers
• Utilize MS Office (Excel, PDF, Outlook) for reporting and documentation
• Ensure compliance with billing policies and healthcare regulations

Preferred Qualifications

• Experience with EHR/EMR systems and insurance guidelines
• 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