Underpayment and Managed Care Contract Specialist

Apply managed care contracting and underpayment recovery expertise to evaluate AI tools that identify payment variances, monitor contract compliance, and surface opportunities to improve healthcare revenue performance.

This remote, hourly role focuses on validating AI-generated analyses against complex payer contracts and claim-payment data. Your work will help improve systems that detect systematic underpayments and support contract compliance monitoring across healthcare revenue cycle operations.

• Identify, analyze, and recover underpayments and payment variances across commercial, Medicare Advantage, and Medicaid managed care contracts.
• Assess AI-generated underpayment 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.
• Perform contract modeling and payment reconciliation to identify 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 potential renegotiation opportunities.
• Track underpayment 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 efforts.
• Annotate AI outputs and provide structured feedback that supports AI training datasets.

• At least 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 within complex contract structures and AI-generated outputs.

• 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.
• Familiarity with AI tools and comfort reviewing AI-generated payment variance content.
• Experience negotiating payer contracts and presenting underpayment analyses to executive leadership.

• Remote position.
• Hourly engagement.

$85 per hour.

Contribute to advanced healthcare AI workflows while working on managed care contracting, revenue-cycle, and payment-variance projects with meaningful operational impact.