Overview ISTA Personnel Solutions South Africa is a global BPO partnering with a USA-based healthcare client providing services within Skilled Nursing Facilities (SNFs), post-acute care, and revenue cycle management. We are seeking a Clinical Case Manager with healthcare experience in SNFs, inpatient authorizations, clinical review, and medical billing. This remote role requires a detail-oriented professional who can manage complex healthcare cases, coordinate with US insurance providers, and ensure compliant billing and authorization outcomes. Important: Applicants must have healthcare experience — candidates without it will not be considered. Key Responsibilities 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 Advantageous Clinical background (Nursing or Allied Health) Experience in sub-acute, SNF, hospice, or hospital environments Exposure to US healthcare BPO operations Strong documentation and reporting discipline Experience with US insurance payers #J-18808-Ljbffr