Underpayment and Managed Care Contract Specialist for AI Evaluation

Validate and improve AI tools that detect payment variances and automate contract compliance monitoring, by applying deep payer contract knowledge and hands-on underpayment recovery experience. This role focuses on identifying systematic underpayments across commercial, Medicare Advantage, and Medicaid managed care contracts and supporting AI training with annotated, structured feedback.

• 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 and clinical or contractual relevance.
• Interpret payer contract terms, including fee schedules, carve-outs, outlier provisions, and payment methodologies, to validate claim payments.
• Perform contract modeling and payment reconciliation to surface systematic underpayment patterns.
• Develop and submit underpayment claims and recovery correspondence to payers, and manage payer dispute resolution.
• Collaborate with managed care contracting teams to identify contract language gaps and opportunities for renegotiation.
• Monitor recovery performance using KPIs such as identified underpayment dollars, recovery rates, and payer response rates.
• Ensure adherence to payer contract terms, HIPAA requirements, and timely filing rules during underpayment recovery.
• Annotate AI outputs and provide structured feedback to create high-quality training datasets for AI systems.

• Minimum 5 years of experience in underpayment recovery, payment variance analysis, or managed care contracting, with demonstrated strength in contract interpretation.
• Deep knowledge of payer payment methodologies, including DRG-based, per diem, percent-of-billed charges, and fee schedule reimbursement.
• Proven 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.
• High attention to detail and the ability to detect payment discrepancies within complex contract structures and AI-generated outputs.

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

• Location: Remote.
• Employment type: Hourly.

• Rate: 85 per hour.

• Candidates must be able to work remotely. No additional eligibility or work authorization details are provided in this posting.

• Contribute to the development of advanced AI systems applied to healthcare revenue integrity.
• Work with a leading AI research organization on high-impact projects that shape managed care contracting and the revenue cycle.
• Gain exposure to cutting-edge AI workflows and cross-functional collaboration with contracting and analytics teams.