Underpayment & Managed-care Contract Specialist
New
United StatesContractMiddle
Salary85 USD per hour
Apply NowOpens the employer's application page
Job Details
- Languages
- English
- Experience
- 5+ years
- Required Skills
- Microsoft ExcelHIPAA
Requirements
- 5+ years of experience in underpayment recovery, payment variance analysis, or managed care contracting.
- Demonstrated expertise in contract interpretation.
- Deep knowledge of payer payment methodologies including DRG-based, per diem, percent-of-billed charges, and fee schedule reimbursement.
- Strong experience with contract modeling, 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.
Responsibilities
- Identify, analyze, 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 modeling 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.
View Full Description & ApplyYou'll be redirected to the employer's site
