Medical Billing & Claims Specialist (US Healthcare) - Remote | EST Hours

ISTA Personnel Solutions South Africa is a fast-growing global BPO, partnering with a US-based healthcare client that provides medical and therapy services to nursing homes through Nurse Practitioners (NPs) and Physician Assistants (PAs).

We are seeking an experienced and detail-oriented Medical Billing & Claims Specialist to take full ownership of the medical claims lifecycle — from submission to denial resolution and payment follow-ups.

This is a revenue-cycle-focused role ideal for someone who understands US healthcare billing processes and can independently manage rejected or denied claims with confidence.

PLEASE NOTE:

Working Hours: Monday – Friday | 9:00 AM – 6:00 PM EST (4:00 PM – 1:00 AM South African time – subject to daylight savings).

Public Holidays: This role requires working on both South African and US public holidays (SA public holidays compensated 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 (SA WFH).

Key Responsibilities:

• Own the full lifecycle of medical claims from submission through to payment posting and resolution
• Investigate, correct, and resubmit denied or rejected claims
• Follow up with US insurance providers regarding unpaid or outstanding claims
• Ensure accurate billing aligned with CPT, ICD-10, and payer guidelines
• Work within the client’s proprietary EMR and Monday.com to track workflows
• Maintain detailed and compliant documentation
• Identify recurring billing issues and recommend process improvements

Requirements:
• Minimum 2+ years of Medical Billing & Coding experience
• Strong understanding of US healthcare systems and insurance processes (advantageous)
• Proven experience handling rejected claims and denial management
• Solid knowledge of CPT, ICD-10, and revenue cycle workflows
• Ability to independently clean up and follow up on claims
• Highly organized, detail-oriented, and proactive
• Strong critical thinking and problem-solving skills
• Comfortable using MS Office and Outlook
• Excellent written and verbal English communication skills

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