Underpayment & Managed-Care Contract Specialist

$85/hr

25 people hired

RemoteUSTechnology5-8 YearsContractPosted Aug 13, 2026

About this role

You will support the evaluation and improvement of AI systems designed to detect healthcare payment variances, monitor payer contract compliance, and identify underpayment recovery opportunities. The role combines managed-care contract expertise, reimbursement analysis, and revenue cycle operations with AI quality evaluation. You will interpret complex payer contracts, validate expected versus actual reimbursement, review AI-generated underpayment alerts, and provide structured feedback to improve systems that optimize net revenue and identify systematic payment discrepancies.

Responsibilities

Underpayment analysis: Identify, investigate, and recover underpayments and payment variances across commercial, Medicare Advantage, and Medicaid managed-care contracts.
AI output evaluation: Review AI-generated underpayment alerts, contract-compliance findings, and payment-variance analyses for accuracy and completeness.
Contract interpretation: Analyze payer agreements including fee schedules, carve-outs, outlier provisions, reimbursement methodologies, and contractual payment terms.
Payment reconciliation: Compare expected reimbursement against actual payments and identify systematic variance patterns.
Contract modelling: Develop reimbursement models using contract terms and historical claim/payment data.
Recovery management: Prepare and submit underpayment claims, disputes, and recovery correspondence to payers.
Contract optimization: Collaborate with managed-care contracting teams to identify problematic contract language and renegotiation opportunities.
KPI monitoring: Track identified underpayment dollars, recovery rates, payer response rates, and related revenue-cycle performance measures.
Compliance: Ensure recovery processes align with payer contract terms, HIPAA requirements, and timely filing deadlines.
AI training support: Annotate AI outputs and provide structured expert feedback for healthcare AI training datasets.

Qualifications

Minimum 5+ years of professional experience in underpayment recovery, payment variance analysis, managed-care contracting, reimbursement analysis, or related healthcare revenue-cycle functions.
Demonstrated expertise in interpreting complex payer contracts and reimbursement terms.
Deep understanding of payment methodologies including DRG-based reimbursement, per diem rates, percent-of-billed charges, and fee schedules.
Strong experience with contract modelling, payment reconciliation, and payer dispute resolution.
Familiarity with managed-care contract management systems and payment-variance detection platforms.
Strong proficiency with Excel-based financial analysis and healthcare revenue-cycle analytics tools.
Ability to identify subtle payment discrepancies across complex contract structures.
Exceptional written and verbal English communication skills.
High attention to detail and ability to critically evaluate AI-generated payment and contract analyses.
Must be based in the United States.