Medical Insurance Denials & Appeals Coordinator (US Healthcare) | EST - Remote

ISTA Personnel Solutions South Africa is a dynamic and fast-growing BPO specialising in providing skilled South African talent to businesses across the United States.

We are currently recruiting on behalf of a respected US behavioural healthcare organisation that provides specialised addiction treatment services. They are seeking a highly organised and detail-oriented Medical Insurance Denials & Appeals Coordinator to join their team.

This is an excellent opportunity for someone with strong administrative skills and experience within healthcare, medical billing, medical aid, hospital administration, or insurance claims who enjoys working in a structured, process-driven environment.

About the Role:

As the Medical Insurance Denials & Appeals Coordinator, you will be responsible for managing insurance appeal cases from start to finish. You will compile supporting documentation, submit appeals to insurance providers, monitor deadlines, follow up on outstanding cases, and ensure the billing team is kept informed throughout the process.

Success in this role requires exceptional attention to detail, excellent organisational skills and the ability to manage multiple cases simultaneously while meeting strict deadlines.

PLEASE NOTE:

• Working Hours: Monday – Friday, 3:00 PM – 12:00 AM South African time (subject to daylight saving time).
• 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:

• Prepare and submit insurance appeal documentation for denied claims.
• Compile and organise supporting clinical and administrative documentation.
• Track all appeals, submission deadlines and follow-up dates.
• Liaise with US insurance companies regarding appeal status and outstanding information.
• Follow up on pending appeals to ensure timely resolution.
• Communicate appeal updates and outcomes to the billing team.
• Request and obtain any outstanding documentation required to support appeals.
• Maintain accurate records and case notes within internal systems.
• Escalate urgent or time-sensitive matters where appropriate.
• Ensure all work is completed accurately, professionally and within required turnaround times.

Minimum Requirements:

• Minimum 2 years' experience in one or more of the following:
• Medical billing
• Medical claims administration
• Medical aid administration
• Healthcare administration
• Hospital administration
• Insurance claims administration
• Excellent written and verbal English communication skills.
• Strong organisational and time management skills.
• Exceptional attention to detail.
• Comfortable working with confidential patient information.
• Confident communicating professionally via telephone and email.
• Proficient in Microsoft Outlook and Microsoft Office.
• Able to work independently and manage multiple priorities.

Highly Advantageous:

• Experience working with US healthcare, medical billing or insurance claims.
• Experience handling denied claims or insurance appeals.
• Knowledge of Revenue Cycle Management (RCM).
• Experience working with behavioural health, hospitals or medical practices.

Important: Previous US healthcare experience is advantageous but not essential. Candidates with strong South African healthcare administration, medical billing or medical aid experience are encouraged to apply.

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