Underpayment & Managed-care Contract Specialist | $85/hr Remote

Overview

This role combines deep expertise in managed care contracting with the development of AI tools for healthcare revenue optimization. You’ll work with a leading AI research lab to evaluate and train systems that detect payment variances and monitor contract compliance automatically. As an Underpayment and Managed Care Contract Specialist, your hands-on knowledge will directly help refine how AI identifies systematic underpayments and improves net revenue.

What You'll Do9

• 1Detect, investigate, and recover underpayments and payment discrepancies across commercial, Medicare Advantage, and Medicaid managed care contracts.
• 2Review AI-generated alerts related to underpayment detection, contract compliance, and variance analysis to ensure accuracy and relevance.
• 3Interpret complex payer contract terms—including fee schedules, carve‑outs, outlier provisions, and reimbursement methodologies—to validate claim payments.
• 4Perform contract modeling and payment reconciliation to uncover recurring underpayment patterns across payer contracts.
• 5Prepare and submit underpayment claims and recovery correspondence to payers in a timely manner.
• 6Partner with managed care contracting teams to identify gaps in contract language and support renegotiation opportunities.
• 7Track and report key recovery metrics such as identified dollars, recovery rates, and payer responsiveness.
• 8Ensure all underpayment activities comply with HIPAA, payer contract terms, and timely filing deadlines.
• 9Annotate AI outputs and provide structured feedback to improve the training datasets for healthcare AI models.

Requirements7

• 1At least 5 years of experience in underpayment recovery, payment variance analysis, or managed care contracting, with a proven ability to interpret payer contracts.
• 2Solid understanding of payer reimbursement methodologies including DRG‑based, per diem, percent‑of‑billed charges, and fee‑schedule models.
• 3Hands‑on experience with contract modeling, payment reconciliation, and payer dispute resolution processes.
• 4Familiarity with managed care contract management systems and payment variance detection tools.
• 5Strong Excel skills for financial analysis and experience with revenue cycle analytics platforms.
• 6Excellent written and verbal English communication skills, with the ability to present findings clearly.
• 7Meticulous attention to detail, especially when identifying discrepancies in complex contract structures and AI‑generated outputs.

Who Should Apply

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