Medical Specialist jobs

OVERVIEW
We are recruiting on behalf of our client for a Medical Billing Specialist to join a US-based healthcare organization on a fully remote basis. This role sits within the revenue cycle function and focuses on insurance follow-up, denial management, and appeals, ensuring that claims are resolved accurately
and collected promptly. The successful candidate will work standard US Eastern Standard Time (EST) business hours and will be expected to manage a high volume of accounts independently. Full system and payer training will be provided to the right candidate.

KEY RESPONSIBILITIES

• Follow up with insurance companies on unpaid, delayed, and underpaid claims via phone and online payer portals
• Review denial explanations, identify root causes, correct errors, and resubmit claims within payer- specified timeframes
• Draft and submit formal appeals with appropriate supporting documentation tailored to each payer's requirements
• Monitor and work aging accounts receivable reports to reduce outstanding balances
• Track all claim activity and maintain accurate, up-to-date notes on every account
• Identify and flag recurring denial trends and billing errors to the wider team for process improvement
• Liaise with clinic and provider staff to obtain missing or incomplete information needed to resolve claims

REQUIREMENTS

• Matric (Grade 12) as a minimum; a relevant National Diploma or NQF Level 5 qualification in Medical Administration, Health Sciences, or a related field is advantageous
• At least 2 years of hands-on experience in US medical billing, including claim submission, denial management, and payment posting
• Working knowledge of CPT, ICD-10, and HCPCS coding, modifiers, and the ability to read and interpret EOBs and ERAs
• Familiarity with US payers including commercial insurers, Medicare, and Medicaid
• Proficient in Microsoft Excel or Google Sheets, and comfortable learning new billing and practice management software
• Reliable home office setup with a stable internet connection and the ability to work US EST business hours

PREFERRED EXPERIENCE

• Prior experience navigating insurance portals such as Availity, UHC, Aetna, or Cigna to verify eligibility, check claim status, and submit documentation
• Experience preparing and submitting formal insurance appeals with supporting clinical or administrative documentation
• Background working within a remote US healthcare billing environment or a medical billing outsourcing company
• Exposure to accounts receivable follow-up workflows and working structured aging reports

KEY COMPETENCIES

• Strong communication skills
• High attention to detail
• Strong organisational skills
• Ability to work independently
• Professionalism and reliability