Clinical Case Manager – US Healthcare
iSTA Solutions
full-time
Posted on:
Location Type: Remote
Location: South Africa
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Job Level
About the role
- End-to-end case management for US healthcare clients
- Review clinical documentation for medical necessity and level of care
- Process inpatient and SNF authorizations
- Coordinate authorizations and claims with providers, payers, and patients
- Manage US healthcare claims from submission to resolution, including denials, rejections, and appeals
- Liaise with Medicare, Medicaid, and commercial payers
- Ensure accurate medical billing and coding (ICD-10, CPT)
- Maintain compliant case notes and documentation
- Collaborate with clinical, administrative, and finance teams
- Ensure HIPAA (US) compliance
- Utilize MS Office for reporting and tracking
- Manage high volumes of emails with accuracy and professionalism
Requirements
- Knowledge of ICD-10 and CPT coding
- 1–3 years healthcare experience
- Proven experience in:
- - Case or account management
- - SNFs or post-acute care
- - Inpatient authorization processing
- - Clinical review
- - Medical billing
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
ICD-10CPT codingmedical billingcase managementauthorization processingclinical reviewinpatient careSNF management
Soft Skills
communicationcollaborationprofessionalismorganizational skills