Insurance Credentialing & Contracting Agent (US Healthcare) | Remote (EST Hrs) at ISTA Personnel Solutions

ISTA Personnel Solutions South Africa is a dynamic and fast-growing BPO company based in South Africa, specializing in providing top-tier operational support to U.S.-based companies. We are not a recruitment agency - we are a dedicated extension of our clients' teams, delivering high-quality service with precision, efficiency, and a personal touch.Role SummaryWe are seeking a detail-oriented and proactive Insurance Credentialing & Contracting Specialist for our U.S.-based client, a growing multi-state provider of Applied Behaviour Analysis (ABA) therapy services for children with autism. This role sits at the intersection of compliance and negotiation: you'll manage the credentialing of newly hired clinicians with insurance providers, and drive the research and outreach needed to get the company in-network with new insurers as they expand into new states.PLEASE NOTE:Working Hours: Monday to Friday, 15:00 PM – 00:00 AM South African time – subject to changes due to daylight saving.Public Holidays: This role requires you to work on both South African and US 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), capable of supporting a wired Ethernet connection, is mandatory. LTE, satellite internet (e.g. Starlink), Rain wireless/mobile broadband, and mobile hotspots will not be considered.Power Backup: A reliable power backup solution - solar, an inverter, or a UPS - capable of sustaining your internet and workstation through load shedding and power outages is required. Applicants without one cannot be considered.Work Environment: This is a fully remote working role.Key Responsibilities:Manage insurance credentialing for newly hired clinicians, updating documentation and portal profiles with individual insurers to ensure compliance and correct billingResearch insurance landscapes in new states as the company expands, identifying which insurers to prioritize for network participationReach out to insurance companies to understand credentialing requirements, application processes, and reimbursement rate structuresNegotiate reimbursement rates with insurers where offered rates fall below competitive benchmarksTrack credentialing and contracting progress, flagging delays or issues proactivelyMaintain accurate, audit-ready records across multiple insurer portals and systemsFollow established workflows and escalate matters appropriately when requiredComplete other ad hoc coordination tasks as neededRequirementsU.S. health insurance experience, including private insurers and MedicaidExcellent communication skills and strong English fluency (verbal and written)Strong critical thinking and independent problem-solving skills, particularly for the contracting/negotiation side of the roleA confident, proactive attitude - comfortable initiating contact with insurers and pushing for better termsDetail-oriented and highly organized, with the discipline to manage multiple portals and deadlines accuratelyBasic computer literacy, including MS Office and Outlook (no advanced Excel skills required)Experience with ABA-specific insurance processes is a strong plus, but not requiredAbility to work independently with minimal day-to-day supervisionIf you are not contacted within 14 working days, please consider your application unsuccessful.

Insurance Credentialing & Contracting Agent (US Healthcare) | Remote (EST Hrs)

Emma

Responsibilities

Skills wanted:

Language(s) required:

About ISTA Personnel Solutions:

apply.workable.com/ista-2/

Admin access needed