Healthcare Claims Recovery Specialist-Remote

ADEC Solutions•Nashville, TN

5d•Remote

About The Position

ADEC Healthcare is seeking an experienced Healthcare Claims Recovery Specialist for a remote, work-from-home position. The role focuses on investigating complex healthcare claims and payment issues, identifying recovery opportunities, and working with healthcare partners to resolve discrepancies. The specialist will use analytical and investigative skills to conduct root cause analysis, support appeals, develop resolution strategies, and collaborate across organizations and teams to improve payment accuracy, recovery outcomes, and operational processes.

Requirements

Experience in healthcare claims, claims research, payment recovery, appeals, reimbursement, or revenue cycle operations.
Strong understanding of hospital or facility operations, provider relations, and healthcare claims workflows.
Proven ability to research and resolve complex claims and payment issues.
Experience working across providers, hospitals, payers, TPAs, and/or healthcare vendors.
Strong analytical, investigative, communication, and problem-solving skills.

Nice To Haves

Hospital- or facility-based healthcare or revenue cycle experience is strongly preferred.

Responsibilities

Investigate complex claims, payment discrepancies, overpayments, and reimbursement issues.
Research and identify payment recovery opportunities and support claims appeals.
Conduct root cause analysis and help develop effective resolution strategies.
Partner with hospitals, healthcare providers, payers, third-party administrators (TPAs), and healthcare vendors.
Collaborate across teams to improve payment accuracy, recovery outcomes, and operational processes.