Role OverviewThe Underpayment & Managed-care Contract Specialist will identify, analyze, and recover underpayments and payment variances across commercial, Medicare Advantage, and Medicaid managed care payer contracts. The role involves evaluating AI-generated underpayment detection alerts, contract compliance outputs, and payment variance analyses for accuracy, and interpreting payer contract terms to validate claim payments.
What You Will Do
The successful candidate will conduct contract modeling and payment reconciliation to identify systematic underpayment patterns, develop and submit underpayment claims and recovery correspondence to payers, and collaborate with managed care contracting teams to identify contract language gaps and renegotiation opportunities.
Why It Might Be a Fit
The ideal candidate will have 5+ years of experience in underpayment recovery, payment variance analysis, or managed care contracting, with demonstrated expertise in contract interpretation. They will also have strong experience with contract modeling, payment reconciliation, and payer dispute resolution, as well as proficiency with Excel-based financial analysis and revenue cycle analytics platforms.
Requirements
- 5+ years of experience in underpayment recovery, payment variance analysis, or managed care contracting
- Deep knowledge of payer payment methodologies
- Strong experience with contract modeling, payment reconciliation, and payer dispute resolution
- 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
Benefits
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