Job Description
We are recruiting on behalf of a growing client in the US seeking a highly detail-oriented and proactive Medical Authorisations & Denials Specialist to support their healthcare operations team.
This role is focused on managing insurance authorisations, following up on denied claims, and ensuring timely approvals and reimbursement processes within the American healthcare system. The ideal candidate will have strong experience working with medical insurance, payer communication, and healthcare administration processes.
Candidates with prior US healthcare experience are strongly preferred. However, candidates with strong South African medical aid authorisations or healthcare administration experience and the ability to adapt quickly to the US system will also be considered.
Key Responsibilities
Submit and manage prior authorisation requests with insurance providers
Follow up on pending authorisations to ensure timely approvals
Investigate and resolve denied or rejected claims
Communicate with insurance companies regarding authorisations, denials, appeals, and claim status updates
Prepare and submit appeals with supporting documentation where required
Maintain accurate records of authorisation and denial activity
Work closely with internal teams to obtain required clinical or billing information
Monitor payer portals, fax communications, and insurance correspondence
Escalate unresolved issues appropriately and provide regular updates to management
Ensure all work is completed accurately and within required turnaround times
Requirements
Previous experience in medical authorisations, denial management, medical billing, revenue cycle management, or healthcare administration
Experience working within the US healthcare system is highly advantageous
Candidates with South African medical aid authorisations or hospital administration experience are encouraged to apply
Strong understanding of insurance processes, claims workflows, and payer communication
Excellent verbal and written English communication skills
Strong attention to detail and organisational skills
Comfortable handling high volumes of follow-ups and administrative tasks
Ability to work independently and manage multiple priorities effectively
Experience with EMR/EHR systems, payer portals, and healthcare software is beneficial
Ability to work aligned to US business hours (EST/CST preferred)
Preferred Experience
Prior experience handling insurance denials and appeals
Knowledge of CPT, ICD-10, and medical terminology
Experience working in behavioural health, ABA, therapy, or outpatient medical environments is advantageous
Familiarity with commercial insurance providers and Medicaid processes
Working Hours
Full-time
Aligned to US business hours (EST/CST)
Location
