Managed Care Contract Specialist
$85 per hourMercor
Job Description
Job Description
About the job
Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark , General Catalyst , Peter Thiel , Adam D'Angelo , Larry Summers , and Jack Dorsey .
Position: Underpayment & Managed-care Contract Specialist
Type: Contract
Compensation: $85/hour
Location: Remote
Role Responsibilities
- Identify, analyze, and recover underpayments and payment variances across commercial, Medicare Advantage , and Medicaid managed care payer contracts.
- Evaluate AI-generated underpayment detection alerts, contract compliance outputs, and payment variance analyses for accuracy.
- Interpret payer contract terms including fee schedules, carve-outs, outlier provisions, and payment methodologies to validate claim payments.
- Conduct contract modeling and payment reconciliation to identify systematic underpayment patterns.
- Develop and submit underpayment claims and recovery correspondence to payers.
- Collaborate with managed care contracting teams to identify contract language gaps and renegotiation opportunities.
- Monitor underpayment recovery KPIs including identified underpayment dollars, recovery rates, and payer response rates.
- Ensure compliance with payer contract terms, HIPAA , and timely filing requirements for underpayment recovery.
- Annotate AI outputs and provide structured feedback to support AI training datasets .
Qualifications
Must-Have
- 5+ years of experience in underpayment recovery, payment variance analysis, or managed care contracting, with demonstrated expertise in contract interpretation.
- Deep knowledge of payer payment methodologies including DRG-based , per diem, percent-of-billed charges, and fee schedule reimbursement.
- Strong experience with contract modeling, payment reconciliation, and payer dispute resolution.
- Familiarity with managed care contract management systems and payment variance detection tools.
- Proficiency with Excel-based financial analysis and revenue cycle analytics platforms.
- Exceptional written and verbal English communication skills.
- High attention to detail with the ability to identify payment discrepancies in complex contract structures and AI-generated outputs.
Preferred
- CHFP , CRCR , or managed care contracting certification.
- Experience with contract management software (e.g., Experian Health , Recondo , or similar).
- Background in hospital, health system, or large physician group underpayment recovery operations.
- Familiarity with AI tools and comfort evaluating AI-generated payment variance content.
- Experience negotiating payer contracts and presenting underpayment analysis to executive leadership.
Application Process (Takes 20–30 mins to complete)
- Upload resume
- AI interview based on your resume
- Submit form
Resources & Support
- For details about the interview process and platform information, please check:
- For any help or support, reach out to: View email address on ziprecruiter.com
PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.
Vacancy posted 10 days ago
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