About this role
Role Overview
Apply your managed care contracting and underpayment recovery expertise to evaluate AI tools that detect payment variances, monitor contract compliance, identify systematic underpayments, and support stronger net revenue performance across healthcare organizations.
Key Responsibilities
- Identify, analyze, and pursue recovery of underpayments and payment variances across commercial, Medicare Advantage, and Medicaid managed care contracts.
- Evaluate AI-generated alerts, contract-compliance findings, and payment-variance analyses for accuracy.
- 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 uncover 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 opportunities for renegotiation.
- Track recovery KPIs, including identified underpayment dollars, recovery rates, and payer response rates.
- Maintain compliance with payer contract terms, HIPAA, and timely-filing requirements for recovery work.
- Annotate AI outputs and provide structured feedback that supports AI training datasets.
Qualifications
- At least 5 years of experience in underpayment recovery, payment variance analysis, or managed care contracting, including 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.
- Contribute to high-impact healthcare AI work focused on managed care contracting and revenue-cycle workflows.
Compensation
- $85 per hour.