Managed Care & Revenue Integrity Lead

Clear Health; United States; On-site; USD 80,000 - 100,000; Full time

Job summary

A healthcare technology startup is seeking a Managed Care & Revenue Integrity Lead to enhance payer contract intelligence and reimbursement accuracy. The role involves analyzing contracts, reviewing underpayment data, and working with cross-functional teams to solve complex billing issues. Ideal candidates will have over 5 years of managed care or healthcare billing experience. This is an entry-level position in a dynamic environment, suitable for those looking to impact both strategy and product development.

Qualifications

• 5+ years of experience in managed care contracting, revenue integrity, or healthcare billing.
• Strong understanding of payer adjudication and reimbursement methodologies.
• Experience working with hospitals, ASCs, or large provider groups.

Responsibilities

• Analyze payer contracts to extract reimbursement methodologies.
• Review 835 remittance data to identify underpayments.
• Oversee outputs from AI-driven reimbursement discrepancy detection.

Skills

Managed care expertise

Analytical skills

Detail-oriented

Communication skills

Job description

About Clear Health

Clear Health is a healthcare technology startup focused on modernizing the patient financial experience for hospitals, ambulatory surgery centers (ASCs), and provider groups. We automate patient billing and payment workflows, and surface actionable payer intelligence to improve reimbursement performance. Our platform combines automation, AI-driven contract intelligence, and real‑world adjudication data to identify underpayments, improve estimate accuracy, and reduce friction for both providers and patients. We operate in a fast-paced, high-growth startup environment where managed care expertise directly informs product, analytics, and strategy.

About the Role

We are hiring a Managed Care & Revenue Integrity Lead to strengthen payer contract intelligence, reimbursement accuracy, and underpayment recovery across hospitals, ambulatory surgery centers (ASCs), and provider groups. This is a highly strategic role at the intersection of managed care, finance, product, and analytics. You will partner directly with leadership and our AI-driven platform to identify systemic payer issues, improve estimate accuracy, and drive meaningful revenue impact, while also serving as an escalation-level expert for complex billing and coding questions.

Responsibilities

• Analyze hospital, ASC, and professional payer contracts to extract reimbursement methodologies, carve‑outs, and pricing logic.
• Translate complex contract language into a structured, machine-readable contract database.
• Identify mismatches between contracted rates, payer adjudication behavior, and applied fee schedules.

Revenue Integrity & Underpayment Analysis

• Review and analyze 835 remittance data to identify, categorize, and quantify underpayments and systemic payer issues.
• Validate expected vs. actual reimbursement at the CPT/HCPCS and claim level.
• Support underpayment recovery and payer escalation strategies in partnership with billing and operations teams.

AI & Analytics Oversight

• Oversee and validate outputs from AI-driven reimbursement discrepancy detection.
• Provide expert feedback to refine classification logic and improve model accuracy.
• Help translate real‑world payer behavior into deterministic rules and AI-assisted insights.
• Serve as an escalation-level expert to help internal support teams interpret complex billing and coding nuances.
• Explain discrepancies between patient estimates and final bills, including payer processing behavior, contract terms, benefit application, and coding considerations.
• Help standardize internal guidance and documentation to improve consistency and confidence in billing communications with patients and clients.

Strategic Insights & Leadership

• Deliver clear, data-driven recommendations to improve contract renewals and payer negotiation strategy.
• Create a feedback loop between contract intelligence, underpayment analytics, and product optimization.
• Act as a trusted subject‑matter expert across finance, managed care, operations, and product teams.

Who You Are

• Deep experience in managed care, billing, and reimbursement.
• Strong understanding of payer adjudication and reimbursement methodologies (commercial, Medicare, Medicare Advantage).
• Comfortable working with 835 remits, fee schedules, and contract language.
• Analytical, detail-oriented, and able to explain complex concepts clearly.
• Able to operate independently while influencing cross‑functional stakeholders.
• Excited to work in a fast-moving environment where your expertise directly shapes product and strategy.

Experience & Background

• 5+ years of experience in one or more of the following: managed care contracting or negotiations; revenue integrity or reimbursement analytics; underpayment identification and recovery; healthcare billing, finance, or payer strategy.
• Experience working with hospitals, ASCs, or large provider groups strongly preferred.

Seniority level

Entry level

Employment type

Full-time

Job function

Health Care Provider

Industries

Hospitals and Health Care