Underpayment & Managed-care Contract Specialist

• Identify, analyse, 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.
• Interpret payer contract terms including fee schedules, carve-outs, outlier provisions, and payment methodologies to validate claim payments.
• Conduct contract modelling and payment reconciliation to identify systematic underpayment patterns.
• Develop and submit underpayment claims and recovery correspondence to payers.
• Collaborate with managed care contracting teams to identify contract language gaps and renegotiation opportunities.
• Monitor underpayment recovery KPIs including identified underpayment dollars, recovery rates, and payer response rates.
• Ensure compliance with payer contract terms, HIPAA, and timely filing requirements for underpayment recovery.
• Annotate AI outputs and provide structured feedback to support AI training datasets.

• 5+ years of experience in underpayment recovery, payment variance analysis, or managed care contracting, with demonstrated expertise in contract interpretation.
• Deep knowledge of payer payment methodologies including DRG-based, per diem, per cent-of-billed charges, and fee schedule reimbursement.
• Strong experience with contract modelling, payment reconciliation, and payer dispute resolution.
• Familiarity with managed care contract management systems and payment variance detection tools.
• Proficiency with Excel-based financial analysis and revenue cycle analytics platforms.
• Exceptional written and verbal English communication skills.
• High attention to detail with the ability to identify payment discrepancies in complex contract structures and AI-generated outputs.

• CHFP, CRCR, or managed care contracting certification.
• Experience with contract management software (e.g., Experian Health, Recondo, or similar).
• Background in hospital, health system, or large physician group underpayment recovery operations.
• Familiarity with AI tools and comfort evaluating AI-generated payment variance content.
• Experience negotiating payer contracts and presenting underpayment analysis to executive leadership.

Project and contracting process: Mercor. Applications continue on the provider's website.