IDR Analyst – Federal and State

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🔥 1 minute ago

🗽 New York – Remote

🗽 New York – Remote

💵 $55k - $65k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

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Pivotal Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

☁️ SaaS

🤝 B2B

💰 Pre seed on 2024-01

Healthcare Insurance • SaaS • B2B

Pivotal Health is a healthcare technology company that provides the industry’s only full-service Independent Dispute Resolution (IDR) platform, combining software, data, and white-glove services to help providers secure fair reimbursement from payers. Their scalable, integrated SaaS platform automates IDR workflows, connects with major revenue cycle management systems, and manages eligibility, submissions, and appeals on behalf of provider organizations. Pivotal Health serves hospitals and specialty practices with a results-driven, outcome-aligned business model (paid after client success) and emphasizes transparency, high client retention, and measurable revenue recovery.

📋 Description

• Evaluate dispute eligibility and documentation: Analyze claim information to ensure cases meet federal IDR or state-specific dispute requirements before submission. • Research and interpret state regulatory requirements: For state-specific work, independently research state laws, regulations, agency guidance, payer requirements, and arbitration procedures; interpret how they apply operationally; and translate that research into clear, reliable instructions and workflows for the rest of the team. • Own inbox and correspondence review: Monitor shared inboxes and respond to incoming emails from payors and IDR entities, tracking follow-ups and next steps for each case. • Ensure accurate case closures: Confirm disputes are closed only when truly resolved, catching premature or missed closures before they affect reimbursement. • Monitor arbitration timelines and correspondence: Track deadlines and review communications from health plans, arbitration entities, and internal teams to ensure cases progress appropriately. • Maintain operational tracking and documentation: Update internal systems and spreadsheets to maintain accurate case records, dispute statuses, and operational metrics. • Support operational improvements: Contribute to refining workflows and documentation as the team builds more scalable dispute management processes, and flag documentation or system issues to our analytics and product teams when case files are incomplete or inaccurate.

🎯 Requirements

• 2–4 years of experience in revenue cycle operations, claims management, or reimbursement/insurance operations • Experience with medical billing or coding; comfortable reading EOBs, claims, and reimbursement codes • Comfortable working in Excel or Google Sheets, including building and using pivot tables, to track cases and data • Strong attention to detail and analytical thinking; ability to review documentation, catch inconsistencies, and determine next steps • Ability to manage a high volume of competing deadlines with strong written communication • Comfortable exercising judgment and asking thoughtful questions rather than waiting for every next step to be prescribed; able to make well-supported recommendations and grow into more independent ownership of your day to day

🏖️ Benefits

• Competitive compensation, including equity • Full health, dental, and vision coverage • Retirement savings plan through 401(k) • Flexible time off • Opportunities for company-wide connection and events