Job description
I STA 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 / Account Manager for Team Lead and Agent roles.
This role requires a minimum of 1-year experience in Account Management 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.
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.
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
If you are not contacted within 14 working days, please consider your application unsuccessful.
