Underpayment & Managed Care Specialist at Mercor

Underpayment & Managed Care Contract Specialist | $85/hr | Worldwide Remote

Mercor is partnering with a leading AI research lab to help shape the next generation of healthcare AI systems. We are seeking experienced Underpayment and Managed Care Contract Specialists to evaluate AI tools designed to detect payment variances and automate contract compliance monitoring. Your expertise will directly influence how AI systems optimise net revenue and identify systematic underpayments across complex payer environments.

Key Responsibilities

• 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 and reliability.
• 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 uncover 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.
• Annotate AI outputs and provide structured feedback to support AI training datasets.

Requirements

• 5+ years of experience in underpayment recovery, payment variance analysis, or managed care contracting.
• Deep knowledge of payer payment methodologies: DRG-based, per diem, percent-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 when reviewing complex contract structures and AI-generated outputs.

Preferred Qualifications

• CHFP, CRCR, or managed care contracting certification.
• Experience with contract management software such as Experian Health, Recondo, or similar platforms.
• Background in hospital, health system, or large physician group underpayment recovery operations.
• Comfort evaluating AI-generated payment variance content and familiarity with AI workflows.
• Experience negotiating payer contracts and presenting underpayment analysis to executive leadership.

Why Join?

• Contribute to the development of frontier AI systems in healthcare.
• Collaborate with a world-class AI research organisation on high-impact projects.
• Gain exposure to cutting-edge AI workflows in managed care contracting and the revenue cycle.
• Help shape the future of healthcare AI from the ground up.