[Hiring] Medical Insurance Denials & Appeals Coordinator @ISTA Personnel Solutions

Role Description

As the Medical Insurance Denials & Appeals Coordinator, you will be responsible for managing insurance appeal cases from start to finish. Your key responsibilities include:

• 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.

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.

Qualifications

• 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.

Requirements

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

Benefits

• Opportunity to work with a respected US behavioural healthcare organisation.
• Fully remote work environment.

Company Description

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.