Underpayment & Managed-care Contract Specialist | $85/hr Remote
Overview
This remote contract role puts your managed care expertise at the center of an AI research project. You'll evaluate machine-learning tools that detect payment variances and monitor contract compliance, helping healthcare providers recover underpaid claims. Your deep understanding of payer contracts and reimbursement methodologies will directly shape how these AI systems learn and improve. You'll work with a leading AI research lab, using your revenue cycle knowledge to train next-generation models. It's a unique opportunity to apply your domain skills in a fast-moving, tech-forward environment.
What You'll Do9
- 1Spot and recoup payment shortfalls and discrepancies across commercial, Medicare Advantage, and Medicaid managed care agreements.
- 2Review AI-generated alerts and compliance reports to verify they correctly flag underpayments and variances.
- 3Break down contract language—fee schedules, carve-outs, outliers, and payment rules—to confirm claims were paid correctly.
- 4Build contract models and reconcile payments to uncover repeated underpayment issues.
- 5Draft and file underpayment appeals and follow-up letters to insurers.
- 6Work with contracting teams to flag weak contract clauses and chances for better terms.
- 7Track key metrics like dollars identified, recovery success, and payer turnaround times.
- 8Make sure all recovery efforts stay within contract rules, HIPAA, and filing deadlines.
- 9Label and comment on AI results to help improve its training data.
Requirements11
- 1At least five years working in underpayment recovery, payment variance analysis, or managed care contracting—with a strong track record in interpreting contracts.
- 2Solid grasp of how payers reimburse: DRG, per diem, percentage of charges, and fee schedules.
- 3Hands-on experience with contract modeling, payment reconciliations, and resolving payer disputes.
- 4Comfortable using managed care contract management platforms and tools that flag payment variances.
- 5Advanced Excel skills for financial analysis, plus working knowledge of revenue cycle analytics software.
- 6Clear, concise communication in English, both written and spoken.
- 7Sharp eye for detail, able to catch payment errors in complicated contract setups and AI-generated outputs.
- 8Preferred: Holds a CHFP, CRCR, or a similar managed care certification.
- 9Preferred: Experience using contract management platforms like Experian Health or Recondo.
- 10Preferred: Previous work in hospital or health system underpayment recovery operations, and comfort reviewing AI-generated content.
- 11Preferred: Skilled at negotiating payer contracts and presenting underpayment analysis to executive leadership.
Who Should Apply
You’re a seasoned managed care contract specialist who has recovered millions in underpayments and knows payer contracts inside out. You’re comfortable working with AI tools and excited to help shape how machine learning tackles revenue cycle challenges. If you have a background in hospital or health system revenue cycle and certifications like CHFP or CRCR, even better.
Salary Insight
$85 per hour, remote, hourly contract.
Location
Required Skills
Application Tip
When you apply, include a specific example of a time you identified and recovered a major underpayment—detail the steps you took and the systems you used. That will show you can translate your experience into the structured feedback this AI project needs.
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