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SC
Stern Cardiovascular Center
Reimbursement Specialist
Career Insights for Claims Adjuster / Specialist (General)
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Based on Tennessee data
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What they do
A Claims Adjuster or Specialist investigates and evaluates insurance claims. Specializes in a particular type of insurance. Inspects property damage, including damage to homes, buildings and cars; reviews claims after they are submitted; may authorize or deny payment for claims. May work directly for insurers or on behalf of claimants.
$73,403 / year median in Tennessee
+16% projected growth
Job Description
Position Summary Stern Cardiovascular is seeking an experienced Reimbursement Specialist to resolve complex accounts receivable denials and unpaid or underpaid insurance claims. The ideal candidate has demonstrated expertise in denial management and claim adjudication across all major healthcare carriers, including Medicare, Medicaid, commercial insurers, and managed care plans. This role reviews payer requirements and remittance information, corrects claim issues, prepares appeals, and follows accounts through final resolution while maintaining accuracy, productivity, and compliance. Key Responsibilities Analyze denial root causes, claim adjudication results, remittance details, payer policies, and filing requirements. Correct claim errors and complete reconsiderations or appeals for denied, rejected, and underpaid claims. Manage assigned work queues, document account activity, and complete timely payer follow-up. Prioritize high-dollar and complex denials, escalate issues when needed, and drive claims to resolution. Identify denial trends and partner with clinical, coding, billing, and other internal teams to prevent recurring issues. Follow CMS, payer, privacy, and company compliance requirements. Qualifications High school diploma or GED required. Two years of medical billing, insurance follow-up, reimbursement, or denial-resolution experience preferred; equivalent education and directly related experience will be considered. Demonstrated expertise in denial management and claim adjudication with all major healthcare carriers, including Medicare, Medicaid, commercial insurers, and managed care plans. Ability to interpret explanations of benefits and electronic remittance advice, identify denial causes, correct claim errors, and prepare effective reconsiderations and appeals. Knowledge of medical terminology, healthcare reimbursement, payer policies, claim edits, CPT coding, and