Underpayment & Managed-care Contract Specialist

$85/hrrate as listed

Review AI-generated underpayment alerts, contract compliance outputs, and payment variance analyses against real payer contract terms, then document where the model's reimbursement math or contract reading goes wrong. Mercor is staffing this for an AI research lab; observed pay is around $85/hr, contract and project-based.

Summary, eligibility guidance and screening preparation are prepared by Sidequest from the platform's posting. Check the source listing before applying.

What the work involves

You'll be handed AI outputs that look like the work product of a revenue integrity analyst: a flagged variance on a DRG-based inpatient claim, a reconciliation between expected and allowed amounts under a percent-of-billed-charges arrangement, a draft underpayment appeal letter to a Medicare Advantage plan. Your job is to decide whether each output is defensible against the contract language it claims to apply — and if it isn't, to say precisely where it broke. That usually means checking whether the model applied the correct fee schedule version, honored carve-outs and implant/high-cost-drug provisions, calculated outlier thresholds correctly, or hallucinated a payment methodology the contract doesn't contain.

Beyond pass/fail judgments, expect structured annotation work: rating outputs against rubrics, writing rationales a non-clinician reviewer can follow, and occasionally authoring gold-standard responses the model is trained toward. Some projects also ask contributors to write adversarial prompts — contract scenarios with stacked lesser-of provisions, retroactive rate changes, or timely-filing edge cases — designed to surface where the system is overconfident.

What the screen looks for

Verifiable operating history. Five-plus years in underpayment recovery, payment variance analysis, or managed care contracting, with specifics: contract types, payer mix, systems used, recovery dollars you can characterize honestly.
Methodology depth under follow-up. Expect the interview to push past definitions into how you'd model a per diem with a stop-loss, or reconcile a case-rate claim where the payer applied an outdated fee schedule.
Calibrated judgment. Reviewers who mark everything wrong are as unhelpful as reviewers who wave things through. The screen probes whether you can distinguish a material payment error from a stylistic difference in how an appeal is worded.
Written clarity. Feedback that trainers can act on, not just a verdict.

Logistics

Remote and asynchronous, with work drawn from a queue rather than scheduled shifts. Contributors typically commit 10–20 hours per week, though project volume fluctuates and some engagements ramp up or pause with little notice. Pay observed at $85/hr for this listing; Mercor sets rates per project and per contributor, so treat the band as a reference point rather than a guarantee. Engagements are 1099 contractor arrangements, and onboarding generally includes a calibration round before paid work begins.

What they look for

5+ years in underpayment recovery, payment variance analysis, or managed care contracting
Deep command of payer payment methodologies: DRG, per diem, case rate, percent-of-billed-charges, and fee schedule reimbursement
Contract interpretation — carve-outs, outlier provisions, lesser-of clauses, stop-loss, and timely filing terms
Contract modelling and payment reconciliation, including Excel-based financial analysis
Clear written English for structured rubric feedback and rationale writing
CHFP, CRCR, or managed care contracting certification (preferred)

Before you apply

Would you pass this screen?

Drawn from what this listing actually requires. Answered in your browser — nothing is sent to us, and we do not store your answers.

Do you have 5 or more years of professional experience in underpayment recovery, payment variance analysis, or managed care contracting?
Years of experience in underpayment or managed care · required
Can you demonstrate working knowledge of at least three of the following payer payment methodologies: DRG-based, per diem, per cent of billed charges, or fee schedule reimbursement?
Knowledge of payer payment methodologies · required
Have you performed contract modelling or payment reconciliation work to identify underpayment patterns?
Contract modelling and reconciliation experience · required
Are you proficient with Excel-based financial analysis, or have you used a revenue cycle analytics or payment variance detection platform?
Excel or financial analysis platform proficiency · preferred
Do you hold a CHFP, CRCR, or other managed care contracting certification?
Certification in healthcare finance or contracting · preferred
Is English your working language, and can you communicate complex contract and payment analysis in writing and verbally with clarity?
English language fluency · required

0 of 6 answered

Included with this listing

Interview prep — 11 questions

Matched to what this platform's screening actually measures. Answer each out loud in 60–90 seconds: claim → concrete example → implication.

What it tests: Whether the candidate has hands-on experience actually reading managed care contracts, quantifying real payment gaps, and executing recovery—not just theoretical knowledge of payer methodologies.
A strong answer: Must name a concrete payer contract term (e.g., fee schedule carve-out, per diem outlier threshold, DRG adjustment rule), describe the specific discrepancy found (with dollar amount or percentage), and explain the recovery method used (direct claim submission, payer dispute process, or escalation).
Where people lose it: Giving a vague or textbook answer ('underpayments happen when claims don't match the contract') rather than a real case: candidate recovers underpayments but may not have owned the full lifecycle or may conflate contract compliance work with actual recovery.