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Role Description

This role involves managing the full recertification and funding eligibility process for residents within supported healthcare facilities in the United States.

• Manage the full medical aid/funding recertification process, including tracking timelines and submission deadlines
• Review resident files to ensure all documentation meets funding and compliance standards
• Coordinate with facility staff to obtain required supporting documentation and outstanding information
• Prepare and submit recertification documentation accurately and timeously
• Communicate with U.S. state funding agencies and facility billing departments where required
• Maintain accurate and up-to-date records within internal systems
• Identify documentation gaps and proactively resolve compliance issues
• Ensure recertifications are completed before eligibility expiration to prevent funding disruptions
• Provide additional administrative and operational support to facilities as needed

Qualifications

• Minimum 2+ years’ experience working within medical aid / medical scheme administration, medical authorization, hospital admissions, patient funding, or healthcare billing environments
• Experience with eligibility verification, funding authorisations, or scheme compliance processes
• Familiarity with U.S. Medicaid and Medicare processes (highly advantageous but not essential — training will be provided)
• Experience handling high-volume case files or time-sensitive administrative processes
• Strong understanding of compliance-driven environments and regulatory documentation standards
• Highly detail-oriented with the ability to manage strict deadlines and multiple files simultaneously
• Experience working with long-term care facilities, rehabilitation centres, or hospital environments (advantageous)
• Comfortable working within digital systems and maintaining accurate electronic records
• Proficient in MS Office and Outlook
• Excellent written and verbal English communication skills

Requirements

• Working Hours: Monday – Friday | 8:00 AM – 5:00 PM EST (2:00 PM – 11:00 PM South African time – subject to daylight savings)
• Public Holidays: This role requires working on both South African and U.S. public holidays (compensation for SA public holidays in accordance with the BCEA)
• Internet Requirements: A fixed fibre line with a minimum speed of 25 Mbps (upload & download) and wired Ethernet capability is mandatory. Applicants without a fixed fibre line cannot be considered
• Power Backup: Reliable backup required to manage load shedding or outages. Applicants without a power backup cannot be considered
• Work Environment: Fully remote

Company Description

ISTA Personnel Solutions is a dynamic, fast-growing BPO company. We are not a recruitment agency — we operate as a dedicated extension of our clients’ teams, delivering high-quality service with precision, efficiency, and a personal touch.