Senior Medical Billing & Coding Specialist - South Africa

Employment Type: Independent Contractor | Full-Time & Part-Time

Work Arrangement: Fully Remote | Specific working hours will depend on the client's requirements.

Hours: 15–40 hours per week

Time Zones: U.S. Eastern, Central, or Pacific Time

About the Role

We are seeking an experienced Senior Medical Billing & Coding Specialist with strong hands-on experience supporting U.S. healthcare practices.

The ideal candidate will have at least 3 years of direct experience in U.S. healthcare billing and coding, preferably working within an actual medical practice or healthcare organization such as Primary Care, Behavioral Health, Mental Health, Dental, Ophthalmology, or another specialty practice.

This is a hands-on role for a professional who understands the U.S. healthcare revenue cycle and can independently manage billing, coding, claims, denials, Accounts Receivable (AR), and payer-related processes.

Key Responsibilities

• Handle day-to-day U.S. medical billing and coding activities.
• Prepare, review, and submit accurate claims to Medicare, Medicaid, and commercial insurance payers.
• Review medical records and billing information to ensure accurate coding and claims submission.
• Apply and interpret CPT, ICD-10, HCPCS, and appropriate modifiers.
• Identify and correct billing and coding errors that may result in claim rejections or denials.
• Manage denials, rejected claims, appeals, and claim corrections.
• Perform Accounts Receivable (AR) follow-up and resolve outstanding insurance balances.
• Investigate unpaid, underpaid, and denied claims and follow up with insurance companies.
• Support the complete Revenue Cycle Management (RCM) process.
• Review EOBs and ERAs and reconcile payments against submitted claims.
• Perform payment posting and identify discrepancies where applicable.
• Verify and maintain accurate patient and insurance information.
• Work with payer portals, clearinghouses, EHR/EMR systems, and billing platforms.
• Identify recurring billing and denial issues and recommend improvements.
• Maintain accurate records and documentation.
• Communicate professionally with insurance companies, healthcare providers, patients, and internal teams when required.
• Follow client-specific billing, coding, compliance, and workflow requirements.

Required Qualifications

• Minimum 3 years of hands-on U.S. medical billing and coding experience.
• Direct experience working within a U.S. healthcare practice, clinic, or healthcare organization.
• Experience supporting one or more healthcare specialties, such as: Primary Care / Family Medicine, Behavioral Health, Mental Health, Dental, Ophthalmology, Specialty Care, & Other U.S. healthcare practice environments
• Strong understanding of the U.S. healthcare Revenue Cycle Management (RCM) process.
• Hands-on experience with: Medical Billing, Medical Coding, Claims Submission, Denial Management, Accounts Receivable (AR), Claim Follow-up, Payment Posting, Insurance Verification and/or Eligibility
• Experience working with Medicare, Medicaid, and commercial insurance.
• Strong understanding of CPT codes, with working knowledge of ICD-10, HCPCS, and modifiers.
• Ability to review claims and identify billing or coding discrepancies.
• Strong understanding of insurance payer processes and requirements.
• Strong computer skills and ability to work with healthcare software, EHRs/EMRs, clearinghouses, and payer portals.
• Excellent written and verbal English communication skills.
• Strong attention to detail and accuracy.
• Ability to work independently in a remote environment.

Preferred Qualifications

• Experience working directly within a specific U.S. healthcare practice or specialty.
• Experience handling complex denials, appeals, and aging AR.
• Experience with multiple insurance payer portals and clearinghouses.
• Experience with healthcare EHR/EMR and practice management systems.
• Medical billing or coding certification such as CPC, CCS, CPB, CCA, or equivalent.

Certification is not required, but a relevant medical billing or coding certification is considered a plus.

What We're Looking For

We are looking for a senior-level, hands-on professional, not someone whose experience is limited to general healthcare administration.

The ideal candidate should be able to demonstrate practical experience managing the U.S. medical billing and coding process, including CPT coding, claims submission, payer follow-up, denials, AR, and RCM.

Candidates with direct experience working inside a medical practice or healthcare organization are strongly preferred.

Application Requirements

When applying, please ensure your CV clearly highlights:

• Your 3+ years of U.S. medical billing and coding experience.
• The specific healthcare practice(s) or specialties you have supported.
• Your experience with Medicare, Medicaid, and commercial insurance.
• Your hands-on experience with CPT, ICD-10, HCPCS, and modifiers.
• Your experience with RCM, denials, AR, claims, and payment posting.
• The EHR/EMR, billing systems, clearinghouses, and payer portals you have used.
• Any relevant medical billing or coding certifications.

Please note: Candidates whose experience is primarily general healthcare administration, without hands-on U.S. medical billing and coding experience, may not be considered.