Clinical Case Manager – US Healthcare

This is a fully remote position, open to applicants in South Africa.

📋 Description

• Complete case management from start to finish for US healthcare clients

• Analyze clinical documentation to determine medical necessity and appropriate level of care

• Handle authorizations for inpatient services and skilled nursing facilities (SNF)

• Coordinate authorizations and claims among providers, payers, and patients

• Oversee US healthcare claims throughout the entire process, from submission to resolution, including handling denials, rejections, and appeals

• Act as a liaison with Medicare, Medicaid, and commercial payers

• Ensure precision in medical billing and coding (ICD-10, CPT)

• Maintain compliant case notes and documentation

• Work collaboratively with clinical, administrative, and finance teams

• Guarantee compliance with HIPAA regulations (US)

• Utilize MS Office for effective reporting and tracking

• Manage a high volume of emails with professionalism and accuracy

⛳️ Requirements

• Familiarity with ICD-10 and CPT coding

• 1–3 years of experience in the healthcare sector

• Demonstrated experience in:

• - Case or account management

• - Skilled nursing facilities (SNFs) or post-acute care

• - Processing inpatient authorizations

• - Conducting clinical reviews

• - Medical billing

🏝️ Benefits

• Competitive salary and performance-based incentives

• Comprehensive health insurance package

• Opportunities for professional development and career advancement

• Supportive and inclusive work environment