Managed Care Contract Specialist

Obsidian; New York (NY); On-site; USD 80,000 - 110,000; Full time

Benefits offered by this job

Opportunity to work on high-impact projects

Collaborate with a world-class AI research organization

Job summary

Obsidian is seeking experienced Underpayment and Managed Care Contract Specialists to enhance AI tools in healthcare. Your expertise in recovery and analysis will assist in optimizing revenue and detecting underpayments. The role involves collaborating with managed care teams and ensuring compliance with contract terms.

Applicants should have over 5 years in underpayment recovery and familiarity with payment variance methodologies. The position contributes to cutting-edge AI workflows and high-impact projects.

Qualifications

• 5+ years of experience in underpayment recovery, payment variance analysis, or managed care contracting.
• Deep knowledge of payer payment methodologies.
• Strong experience with contract modelling and payment reconciliation.

Responsibilities

• Identify, analyze, and recover underpayments across payer contracts.
• Evaluate AI-generated underpayment detection alerts for accuracy.
• Conduct contract modelling and payment reconciliation.

Skills

Underpayment recovery

Payment variance analysis

Contract interpretation

Excel-based financial analysis

Attention to detail

Education

Managed care contracting certification (CHFP, CRCR)

Tools

Contract management software

Job description

Mercor is working with a leading AI research lab to improve the capabilities of next‑generation 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 in payer contract interpretation, payment variance analysis, and underpayment recovery will help AI systems optimise net revenue and identify systematic underpayments.

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.
• 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 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.

Requirements

• 5+ years of experience in underpayment recovery, payment variance analysis, or managed care contracting, with demonstrated expertise in contract interpretation.
• Deep knowledge of payer payment methodologies including DRG‑based, per diem, per cent‑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 with the ability to identify payment discrepancies in complex contract structures and AI‑generated outputs.

Preferred Qualifications

• CHFP, CRCR, or managed care contracting certification.
• Experience with contract management software (e.g., Experian Health, Recondo, or similar).
• Background in hospital, health system, or large physician group underpayment recovery operations.
• Familiarity with AI tools and comfort evaluating AI‑generated payment variance content.
• 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.
• Gain exposure to cutting‑edge AI workflows in managed care contracting and the revenue cycle.
• Opportunity to work on high‑impact projects shaping the future of healthcare AI.