Medical Aid Authorizations Specialist (US Healthcare) - Remote (EST Hours)

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.

We are seeking a highly detail-driven Medical Aid Authorizations Specialist to manage the full recertification and funding eligibility process for residents within supported healthcare facilities in the United States.

This role is ideal for someone with strong experience in medical aid / medical scheme administration, authorization, eligibility verification, compliance documentation, and deadline-driven case management within a regulated healthcare environment.

You will be working alongside a team that delivers administrative, financial, and operational support to nursing homes and long-term care facilities across the United States, ensuring continued funding eligibility and regulatory compliance for residents.

PLEASE NOTE

• 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.

Key Responsibilities

• 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

Requirements:

• 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

If you have not been contacted within 14 working days, please consider your application unsuccessful.