Note: The job is a remote job and is open to candidates in USA. CapitexAI is a company specializing in revenue cycle management, and they are seeking a Revenue Cycle Analyst to drive systematic underpayment recovery and contract compliance validation across various payer portfolios. The role involves evaluating payment variances and supporting the development of contract intelligence tools.
Responsibilities
- Identify and recover underpayments and payment variances across payer contracts, applying working knowledge of DRG-based, per diem, percent-of-billed charges, and fee schedule reimbursement methodologies
- Interpret complex payer contract terms — including fee schedules, carve-outs, outlier provisions, and bundled payment structures — to validate claim payments and flag systematic discrepancies
- Conduct contract modelling and payment reconciliation to uncover patterns of underpayment across payer classes; develop and submit recovery correspondence accordingly
- Evaluate model-generated underpayment alerts, contract compliance outputs, and payment variance analyses for clinical and financial accuracy, providing structured annotation and feedback
- Monitor recovery performance metrics including identified underpayment volume, recovery rates, and payer dispute response timelines
- Identify contract language gaps and escalate renegotiation opportunities to managed care contracting leadership
Skills
- Demonstrated expertise in underpayment recovery, payment variance analysis, or managed care contracting with a track record in complex multi-payer environments
- Deep command of payer payment methodologies across DRG, per diem, percent-of-billed charges, and fee schedule structures
- Proven ability to conduct contract modelling, payer dispute resolution, and reconciliation at scale
- Proficiency in Excel-based financial analysis and familiarity with revenue cycle analytics platforms or contract management systems
- Working knowledge of HIPAA compliance requirements and timely filing standards applicable to underpayment recovery
- Exceptional written communication skills; ability to produce precise recovery correspondence and structured analytical documentation
- CHFP, CRCR, or managed care contracting certification (Experian Health, Recondo, or equivalent platform experience a plus)
- Background in hospital, health system, or large physician group underpayment operations with exposure to executive-level underpayment reporting
- Comfort evaluating and annotating automation-generated outputs within a structured feedback workflow
Benefits
- Flexible
- Remote
Company Overview