Medical Billing Specialist

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