Underpayment & Managed-care Contract Specialist

Role Overview

Apply your managed care contracting and underpayment recovery expertise to evaluate AI-generated analyses that identify payment variances, monitor contract compliance, and support improved net revenue performance in healthcare.

Key Responsibilities

• Identify, analyze, and pursue recovery of underpayments and payment variances across commercial, Medicare Advantage, and Medicaid managed care contracts.
• Assess AI-generated underpayment alerts, contract-compliance outputs, and payment-variance analyses for accuracy.
• Interpret payer contract provisions, including fee schedules, carve-outs, outlier terms, and payment methodologies, to validate claim payments.
• Perform contract modeling and payment reconciliation to identify systematic underpayment patterns.
• Prepare and submit underpayment claims and recovery correspondence to payers.
• Partner with managed care contracting teams to identify contract-language gaps and renegotiation opportunities.
• Track recovery metrics, including identified underpayment dollars, recovery rates, and payer response rates.
• Maintain compliance with payer contract requirements, HIPAA, and timely-filing rules for recovery activity.
• Annotate AI outputs and provide structured feedback for AI training datasets.

Qualifications

• At least 5 years of experience in underpayment recovery, payment variance analysis, or managed care contracting, with demonstrated contract-interpretation expertise.
• Deep knowledge of DRG-based, per-diem, percent-of-billed-charges, and fee-schedule reimbursement methodologies.
• Experience with contract modeling, payment reconciliation, and payer dispute resolution.
• Familiarity with managed care contract-management systems and payment-variance detection tools.
• Proficiency in Excel-based financial analysis and revenue-cycle analytics platforms.
• Exceptional written and verbal English communication skills.
• Strong attention to detail and the ability to identify discrepancies in complex contract structures and AI-generated outputs.

Preferred Qualifications

• CHFP, CRCR, or a managed care contracting certification.
• Experience with contract-management software such as Experian Health, Recondo, or similar tools.
• Experience in hospital, health system, or large physician-group underpayment recovery operations.
• Comfort evaluating AI-generated payment-variance content.
• Experience negotiating payer contracts and presenting underpayment analyses to executive leadership.

Work Terms

• Remote, hourly engagement.

Compensation

• $85 per hour.