Insurance Claims & Credentialing Specialist
US Medical Billing, Insurance Claims & Credentialing Specialist
Remote | South Africa
Hours EST: 8am - 5pmBudget: Up to R14,000K depending on experience
We're looking for a detail-oriented Insurance Claims & Credentialing Specialist to join a growing ABA therapy organization supporting clients across the United States.
This role is ideal for someone with experience in US medical billing, insurance claims, provider credentialing, and revenue cycle management who thrives in a fast-paced, process-driven environment. You'll play a key role in ensuring providers are credentialed correctly, claims are submitted accurately, and reimbursements are received on time.
Key ResponsibilitiesInsurance Claims Management
- Submit, monitor, and manage insurance claims for ABA therapy services.
- Review, reconcile, and follow up on unpaid, denied, or underpaid claims.
- Investigate and resolve claim denials, rejections, and billing discrepancies.
- Communicate with insurance companies regarding claim status, payments, appeals, and outstanding balances.
- Ensure timely claim resolution to support healthy cash flow.
- Manage provider credentialing and recredentialing with commercial and government insurance payers.
- Complete and maintain provider enrolment applications through payer portals.
- Track credentialing timelines and proactively follow up with insurance companies.
- Maintain accurate provider records and ensure all credentialing documentation remains current.
- Obtain and manage prior authorizations to ensure uninterrupted patient services.
- Ensure compliance with payer guidelines, billing regulations, and internal policies.
- Maintain accurate documentation across all claims and credentialing activities.
- Collaborate with internal teams to support efficient revenue cycle operations and resolve billing issues.
- Previous experience with US medical insurance claims and billing .
- Experience with provider credentialing and payer enrolment .
- Strong understanding of insurance claims processes, denials, appeals, and reimbursements.
- Excellent attention to detail and organisational skills.
- Strong written and verbal English communication skills.
- Ability to manage multiple priorities while meeting deadlines.
- Proficiency using payer portals and medical billing systems.
- Experience in ABA therapy or behavioural health will be highly advantageous.
- Fully remote position.
- Opportunity to work with a growing US healthcare organization.
- Supportive and collaborative team environment.
- Long-term career growth within healthcare administration.
