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Medical Claims Processing Jobs in Tennessee (NOW HIRING)

Ourhrconnect

Technician, Accounting III

Nashville, TN · On-site

$40K - $53K/yr

A Medicare Claims Overpayment Claims Processor identifies, investigates, and recovers incorrectly paid medical claims by analyzing payment data, verifying overpayments from sources like duplicate ...

Ourhrconnect

Technician, Accounting III

Nashville, TN · On-site

$40K - $53K/yr

A Medicare Claims Overpayment Claims Processor identifies, investigates, and recovers incorrectly paid medical claims by analyzing payment data, verifying overpayments from sources like duplicate ...

RemX

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Medical Billing Insurance Follow Up Specialist

Knoxville, TN · On-site

$16 - $18/hr

Experience working with insurance carriers and claims processing * Strong analytical and problem ... If you have a background in medical billing and insurance follow-up and are looking for your next ...

Corvel

Claims Assistant

Franklin, TN · Remote

$13.38 - $23.42/hr

Process payments, as needed * Process form letters, state forms and reports * Assist claims ... A comprehensive benefits package is available for full-time regular employees and includes Medical ...

New

Corvel

Claims Assistant

Franklin, TN · On-site

$13.38 - $23.42/hr

Process payments, as needed * Process form letters, state forms and reports * Assist claims ... A comprehensive benefits package is available for full-time regular employees and includes Medical ...

New

Adecco

Medical Biller

Knoxville, TN · On-site +1

$18 - $23/hr

What You'll Do ✅ Process and follow up on patient billing and insurance claims ✅ Review ... medical terminology and claims processing preferred ✔ Familiarity with insurance plans, payer ...

Wellpath

Pharmacy Claims Reconciliation Specialist

Franklin, TN · On-site

$19 - $25.75/hr

... medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members ... The Pharmacy Claims Reconciliation Specialist also helps improve processes, ensure compliance, and ...

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All JobsMedical Claims Processing JobsMedical Claims Processing Jobs in Tennessee

Medical Claims Processing information

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$17

$23

How much do medical claims processing jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for medical claims processing in Tennessee is $17.67, according to ZipRecruiter salary data. Most workers in this role earn between $15.72 and $19.62 per hour, depending on experience, location, and employer.

What are some common challenges faced in medical claims processing, and how can professionals address them?

Medical claims processors often encounter challenges such as handling complex insurance policies, navigating frequent regulatory changes, and ensuring the accuracy of coding and billing information. To address these issues, professionals need to stay updated with industry regulations, maintain strong attention to detail, and communicate effectively with healthcare providers and insurance companies. Ongoing training and the use of specialized software can also help streamline workflows and minimize errors, making the process more efficient.

What is medical claims processing?

Medical claims processing is the administrative procedure of reviewing, validating, and handling healthcare claims submitted by providers to insurance companies or payers for reimbursement. This process involves checking the accuracy of the submitted information, verifying patient eligibility and coverage, and ensuring that services are medically necessary and properly coded. Claims processors work to approve, deny, or request additional information to resolve claims, ultimately ensuring that healthcare providers receive payment and patients are billed accurately.

Do you need a degree to be a medical claims processor?

A degree is not typically required to become a medical claims processor, but employers often prefer candidates with a high school diploma or equivalent. Relevant skills include knowledge of medical billing, coding, and claims processing software, and some certifications can enhance job prospects.

What is the difference between Medical Claims Processing vs Medical Billing?

AspectMedical Claims ProcessingMedical Billing
CredentialsTypically requires knowledge of insurance policies and claims proceduresRequires understanding of coding and billing practices
Work EnvironmentOften in insurance companies, healthcare providers, or claims processing centersPrimarily in healthcare provider offices or billing companies
Employer & IndustryInsurance companies, healthcare providers, third-party administratorsHospitals, clinics, medical practices, billing services

Medical Claims Processing focuses on reviewing and submitting insurance claims for reimbursement, ensuring compliance with policies. Medical Billing involves coding patient services and generating bills for patients and insurers. While related, Claims Processing emphasizes claim review and approval, whereas Billing centers on creating accurate invoices for services rendered.

What are the key skills and qualifications needed to thrive as a medical claims processor, and why are they important?

To thrive as a Medical Claims Processor, you need a solid understanding of medical terminology, insurance policies, and claims procedures, often supported by a high school diploma or associate degree. Familiarity with claims management software, healthcare coding systems (ICD-10, CPT), and electronic health record (EHR) systems is typically required. Attention to detail, strong organizational skills, and effective communication help ensure accuracy and timely processing. These skills are crucial for minimizing errors, reducing claim denials, and supporting efficient healthcare reimbursement processes.

How to get a job as a medical claims processor?

To become a medical claims processor, candidates typically need a high school diploma or equivalent, with some roles preferring postsecondary training in healthcare administration or related fields. Relevant skills include attention to detail, knowledge of medical billing and coding, and proficiency with claims processing software. Certification such as the Certified Medical Reimbursement Specialist (CMRS) can improve job prospects, and previous experience in healthcare or insurance is often beneficial.
What are the most commonly searched types of Medical Claims Processing jobs in Tennessee? The most popular types of Medical Claims Processing jobs in Tennessee are:
What are popular job titles related to Medical Claims Processing jobs in Tennessee? For Medical Claims Processing jobs in Tennessee, the most frequently searched job titles are:
What job categories do people searching Medical Claims Processing jobs in Tennessee look for? The top searched job categories for Medical Claims Processing jobs in Tennessee are:
What cities in Tennessee are hiring for Medical Claims Processing jobs? Cities in Tennessee with the most Medical Claims Processing job openings:
Medical Claims Processing jobs near you
Infographic showing various Medical Claims Processing job openings in Tennessee as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 17% Part Time, and 5% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $36,752 per year, or $17.7 per hour.

Coding and Medical Records Auditor

American Health Partners

Franklin, TN • On-site

Full-time

Posted 23 days ago

Job description

JOB SUMMARY:
TruHealth is the clinical arm of the health plan and supplies the model of care. The Coding and Medical Records Auditor will be
responsible for conducting coding audits prior to claims submission. This position will ensure appropriate and accurate coding is
applied for each member of the plan. Additionally, post-payment coding reviews may be performed with coding education
correspondence sent to providers
The Coding and Medical Records Auditor will be responsible for conducting coding audits prior to claims submission. This position will ensure appropriate and accurate coding is applied for each member of the plan. Additionally, post-payment coding reviews may be performed with coding education correspondence sent to providers.
ESSENTIAL JOB DUTIES:
To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.
  • Review claims prior to billing to provide a proactive level of accuracy.
  • Assess trends; communicate appropriate education both individually to staff and collectively as an organization.
  • Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries as needed to verify and ensure the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered.
  • Conduct pre-claim and post-claim coding audits to ensure accurate claims' denials.
  • Work closely with delegated claim processor to ensure errors are reviewed and corrected prior to final payment.
  • Assist with validation audits to evaluate medical record documentation to ensure coding accurately reflects and supports relevant coding based on the ICD-10 code submitted to CMS and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions applicable to Medicare Risk Adjustment reimbursement initiatives.
  • Work assigned coding projects to completion.
  • Provide a high level of customer service to internal and external customers by consistently meeting and/or exceeding expectations including but not limited to quality and productivity.
  • Escalate appropriate coding audit issues to management as required and follow departmental/organizational policies and procedures.
  • Maintain required levels of production and quality standards as established by management.
  • Work directly with provider representatives and executive directors on Letters of Agreement (LOAs) to ensure appropriate coding methodology and reimbursement.
  • Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of coding standards.
  • Follow all appropriate Federal and State regulatory requirements and guidelines applicable to Health Plan operations or as documented in company policies and procedures.
  • Participate in and support ad-hoc coding audits as needed.
  • Other duties as assigned

EXPERIENCE:
  • 3 years HCC coding and/or coding and billing required
  • 5 years HCC coding and/or coding and billing preferred
  • 2+ years of complex claims processing and/or coding auditing experience in the health insurance industry or medical health care delivery system recommended.
  • 2 + years of experience in managed healthcare environment related to claims' and/or coding audits recommended.
  • 2 year(s): Knowledge of standard coding and reference materials used in a claim setting, such as CPT4, ICD10, HCPCS and others
  • 2 year(s): Knowledge of CMS requirements regarding claims processing and coding; especially Skilled Nursing Facility and other complex claim processing rules and regulations
  • 2 year(s): Coding/auditing claims for Medicare and Medicaid plans.
  • 2 year(s): Experience in managed healthcare environment related to coding audits
  • 2 year(s): Complex claims processing and/or coding experience in the health insurance industry or medical health care delivery system

LICENSE/CERTIFICATION: REQUIRED (any of the following):
  • Certified Professional Coder (CPC)
  • Certified Risk Coder (CRC) • Certified Coding Specialist (CCS)
  • Certified Documentation Integrity Practitioner (CDIP)
  • Certified Clinical Documentation Specialist ( CCDS)
  • Registered Health Information Technician (RHIT)

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.
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About American Health Partners

Sourced by ZipRecruiter

American Health Partners is a family of six divisions staffed by outstanding employees who care deeply about others. Since our inception more than 45 years ago, we have been committed to bringing the highest quality healthcare available to our communities. That commitment continues to serve us, our patients, our customers and our partners well. Today, our diverse healthcare offerings serve nearly 12,000 individuals annually across multiple states. We operate in both urban and rural communities where people need healthcare close to home. By working closely with hospitals and other providers, we offer cost-effective options that give individuals greater control over their healthcare.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Franklin, TN, US

Year founded

1976

Social media

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