Underpayment & Managed Care Contract Specialist

Role Overview

Apply your managed care contracting and underpayment recovery expertise to evaluate AI tools that detect payment variances and monitor contract compliance. Your work will help validate AI-generated analyses, identify systematic underpayments, and support stronger net revenue performance across healthcare organizations.

Key Responsibilities

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

Qualifications

• 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.
• Background in hospital, health system, or large physician-group underpayment recovery operations.
• Familiarity with AI tools and comfort assessing AI-generated payment-variance content.
• Experience negotiating payer contracts and presenting underpayment analysis to executive leadership.

Work Terms

• Remote, hourly engagement.

Compensation

• $85 per hour.

Opportunity

• Contribute to advanced healthcare AI workflows spanning managed care contracting and the revenue cycle.
• Work on high-impact projects that help shape the future of healthcare AI.