AI-Powered Underpayment Recovery Specialist

Mercor; New York (NY); Remote; USD 110,000 - 170,000; Full time

Job summary

Mercor is seeking experienced professionals to analyze and recover underpayments within managed care contracts, leveraging AI tools to detect variances and ensure accurate payments. You will interpret complex payer terms, model contract implications, and drive continuous improvement in revenue integrity across commercial, Medicare Advantage, and Medicaid line items.

Role requires 5+ years of experience, strong Excel skills, and the ability to communicate effectively with stakeholders.

Qualifications

• 5+ years of underpayment recovery or managed care contracting experience.
• Expertise in contract interpretation.
• Knowledge of DRG-based, per diem, per cent-of-billed charges, and fee schedule reimbursement.
• Proficiency with Excel-based financial analysis and revenue cycle analytics.
• Strong written and verbal English communication.
• Attention to detail in complex contracts and AI outputs.

Responsibilities

• Identify and recover underpayments and payment variances across commercial, Medicare Advantage, and Medicaid managed care payer contracts.
• Evaluate AI-generated underpayment detection alerts and payment analyses for accuracy.
• Interpret payer contract terms including fee schedules, carve-outs, and payment methodologies.
• Conduct contract modelling and payment reconciliation to identify underpayment patterns.
• Develop and submit underpayment claims and recovery correspondence to payers.
• Collaborate with managed care contracting teams to identify contract gaps and renegotiation opportunities.
• Monitor underpayment recovery KPIs including dollars recovered and payer response rates.
• Ensure compliance with payer contract terms, HIPAA, and timely filing requirements.
• Annotate AI outputs and provide feedback to support AI training datasets.

Skills

Underpayment recovery

Payment variance analysis

Contract interpretation

Excel

Revenue cycle analytics

English communication

Tools

Experian Health

Recondo

Job description

Mercor is seeking experienced professionals to analyze and recover underpayments within managed care contracts, leveraging AI tools to detect variances and ensure accurate payments. You will interpret complex payer terms, model contract implications, and drive continuous improvement in revenue integrity across commercial, Medicare Advantage, and Medicaid line items.

Role requires 5+ years of experience, strong Excel skills, and the ability to communicate effectively with stakeholders.