Analyst, State Dispute Operations

🕒 October 19

🇺🇸 United States – Remote

💵 $26 - $30 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

⚙️ Operations

🚫👨‍🎓 No degree required

👻 Ghost score 20%

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Pivotal Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

💰 Pre seed on 2024-01

Healthcare • Consulting • Logistics

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

• Prepare and submit state dispute and arbitration requests through state portals, agencies, and arbitration entities • Follow each state’s documentation and formatting requirements • Track filing and response deadlines • Process filing fees and confirm payers pay awarded amounts • Follow up when payments are late or incorrect • Monitor shared inboxes • Respond to payers, state agencies, and arbitration entities • Log next steps for each case • Update internal systems and spreadsheets with case details and statuses • Close disputes only once they are fully resolved • Follow state references for eligibility, deadlines, forms, and fees • Flag rule changes or gaps so state references remain current • Notify analytics and product teams when case files are incomplete or inaccurate • Collaborate with analytics and product teams to keep case data clean

🎯 Requirements

• 2–4 years of experience in data management, operational tracking, revenue cycle operations, claims management, or insurance operations • Experience with medical billing or coding • Comfortable reading EOBs, claims and reimbursement codes • Comfortable in Excel or Google Sheets, including pivot tables • Highly detail-oriented and able to catch inconsistencies in documents and data • Able to manage high volume and competing deadlines accurately • Comfortable following detailed, state-specific processes • Clear written communicator who asks good questions and flags problems early • Familiarity with the federal No Surprises Act and its interaction with state surprise billing laws • Prior experience with state arbitration programs, such as New York, New Jersey, or Texas • Experience with Asana, Metabase, or other project management tools • Medical billing/coding certification, such as CPC, is extra credit • Must be authorized to work in the United States without current or future employer sponsorship • Reside in CST or EST

🏖️ 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 • Remote work arrangement

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