Senior Manager, State IDR

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🕒 vor 24 Tagen

🗽 New York – Remote

🗽 New York – Remote

💵 $150.000 - $170.000 / Jahr

⏰ Vollzeit

🟠 Senior

👔 Manager

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Pivotal Health

WebsiteLinkedInAlle Stellen

51 - 200 Mitarbeiter

🏥 Gesundheitswesen

💼 Beratung

📦 Logistik

💰 Pre seed im 2024-01

Healthcare • Consulting • Logistics

Pivotal Health ist ein Technologieunternehmen im Gesundheitswesen, das die einzige umfassende Plattform für ein unabhängiges Streitbeilegungsverfahren (IDR) in der Branche anbietet. Es kombiniert Software, Daten und erstklassige Dienstleistungen, um Anbietern zu helfen, eine faire Erstattung von Kostenträgern zu sichern. Die skalierbare und integrierte SaaS-Plattform automatisiert IDR-Workflows, verbindet sich mit wichtigen Systemen für das Revenue Cycle Management und verwaltet die Berechtigung, Einreichungen und Einsprüche im Auftrag von Anbieterorganisationen. Pivotal Health bedient Krankenhäuser und Facharztpraxen mit einem ergebnisorientierten Geschäftsmodell (Bezahlung nach Erfolg des Kunden) und legt Wert auf Transparenz, hohe Kundenbindung und messbare Umsatzrückgewinnung.

Beschreibung

• Own state arbitration strategy end to end. Decide which states we pursue, in what order, and why. Turn a function that's been informal and reactive into a deliberate, prioritized roadmap. • Build the state filing process from the ground up. Formalize how, when, and where we file across the ~20 states with real volume, replacing ad hoc handling with a repeatable operating model. • Lead and grow the State Arbitration team. Take over management of the existing team, including direct oversight of state arbitration staff, and hire quickly to scale the function as it formalizes. • Recover misrouted claims. Identify volume currently flowing into the federal IDR process that should be filed at the state level, and build the workflows to catch and correctly route it going forward. • Partner with Data & Analytics. Work closely with the analytics team to surface trends in claims and outcomes, and use that data to sharpen which states and strategies we invest in. • Drive the product roadmap for state arbitration. Partner with Product and Engineering to translate operational reality (eligibility rules, filing requirements, remittance advice complexity) into the tools and automation the team needs. • Own remittance advice and eligibility determination. Bring clarity to where claims sit between federal and state processes, and build the judgment calls into scalable, documented logic rather than one-off decisions. • Take on broader department management. Assume ownership of responsibilities currently held by Operations leadership, running state arbitration as its own accountable department rather than a shared responsibility.

🎯 Anforderungen

• 8–10 years of progressive management experience, with real depth in Revenue Cycle Management or an adjacent industry • Experience managing operational or administrative teams, not just corporate or credentialed hires • A track record of walking into ambiguity and building structure • Working knowledge of the payor landscape, state arbitration, and IDR entities • Comfortable with Excel and data analysis; SQL and AI tooling experience is a strong plus • Open, honest, and direct: you over-communicate by default and you trust your team while still verifying the work • A strategic thinker who's equally willing to be hands-on when a process needs to be built or rebuilt from scratch

🏖️ Vorteile

• 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