3 Medical Appeals jobs in South Africa

Job Title:
Billing & Medical Claims Processor

Schedule:
Monday – Friday | 8:00 a.m. – 5:00 p.m. PST

(5:00 p.m. – 2:00 a.m. South Africa Standard Time)

Location:
Remote – Based in South Africa

Reports To:
Director of Accounting & Finance

About the Opportunity

Total Care Connections—one of the largest home care providers in Arizona and Colorado—is seeking a detail-oriented and experienced
Billing & Medical Claims Processor
to join our growing team.

This full-time remote role is based in South Africa but aligned with U.S. Pacific Standard Time hours. The ideal candidate has strong English communication skills, experience in U.S. medical billing and claims management, and a proven ability to work in a fast-paced healthcare environment.

About the Role

As a Billing & Medical Claims Processor, you will be responsible for the
end-to-end revenue cycle process
, including billing, claims submission, adjudication, payment posting, collections, and accounts receivable management. You will ensure accuracy, compliance, and timeliness in all financial transactions, while serving as a key support to the Director of Accounting & Finance.

This role is critical to ensuring that Total Care Connections maintains healthy cash flow and compliance across all payer types.

Key Responsibilities
Billing & Claims Management

• Prepare, review, and submit accurate claims through
  Office Ally
  and
  Waystar
  for private insurance, Medicaid, Medicare, VA, long-term care insurance, and private pay clients.
• Verify insurance eligibility and benefits prior to billing.
• Ensure all claims meet payer-specific requirements, HIPAA regulations, and industry coding standards.
• Track, manage, and resolve claim rejections and denials; submit corrections and appeals as needed.
• Maintain claim status logs and follow up with payers to ensure timely adjudication.

Accounts Receivable & Collections

• Post payments (EFT, ACH, credit card, checks) accurately and reconcile against remittance advice (ERA/EOB).
• Manage client invoicing, account statements, and collections activities, including outbound calls for past-due accounts.
• Monitor aging reports and escalate overdue balances.
• Process refunds, adjustments, and write-offs in accordance with company policy.
• Maintain accurate A/R records for monthly reporting.

Revenue Cycle Operations

• Perform daily reconciliation of deposits and payment postings.
• Conduct audits of claims and payments to identify errors, trends, or compliance risks.
• Support prior authorization requests and documentation when required.
• Collaborate with schedulers, nurses, and caregivers to resolve billing discrepancies tied to services rendered.
• Assist with monthly close by preparing A/R and collections reports.

Compliance & Process Improvement

• Stay current with Medicare, Medicaid, and private payer billing regulations.
• Ensure strict adherence to HIPAA and internal confidentiality requirements.
• Identify opportunities to improve billing efficiency and accuracy.
• Support internal and external audits related to billing and claims.

Qualifications

• Bachelor's degree preferred (Accounting, Finance, Healthcare Administration, or related field).
• Minimum 2–3 years of experience in U.S. medical billing and claims processing, preferably in home health or healthcare.
• Proficiency with
  Office Ally, Waystar, ERA/EOB posting, and payment systems (ACH, credit card processing).
• Strong knowledge of medical claims adjudication, payer rules, and denial management.
• Excellent English communication skills (written and spoken).
• Highly detail-oriented, organized, and able to manage multiple tasks in a fast-paced environment.
• Comfortable making professional collections calls to clients and payers.
• Ability to work 8:00 a.m. – 5:00 p.m. PST (night shift in South Africa).

Our client, an IT software provider in the healthcare industry, is in search of a Medical Aid Claims Administrator to join their dynamic and fast-paced Admin department.

Duties & Responsibilities:

• Manage the Doctor's account remotely.
• Reconcile remittances.
• Query outstanding claims.
• Resubmit outstanding claims.
• Maintain a low age analysis.
• Follow up on short payments.
• Flag claims regularly with updates.
• Clear Ontime rejections.
• Submit query reports to clients.
• Selecting correct scheme agreements.
• Maintain the ERA database.
• Identify tariff issues
• Constant liaison with client and logging of communication.
• General filing and admin.

Requirements:

• 2 years experience as a medical aid claims administrator (Non-negotiable).
• Deadline driven (Client turnaround time: 48 hours)
• Independent thinker; problem solver.

Qualifications:

• Matric certificate.

CTC includes Medical Aid

Job Type: Full-time

Pay: Up to R11 000,00 per month

Application Question(s):

• What is the difference between a tariff and an ICD-10 code?
• What makes a claim patient liable?

Education:

• High School (matric) (Required)

Experience:

• Medical Aid Claims: 2 years (Required)

Work Location: In person