Senior Manager, State IDR

Job not on LinkedIn

🔥 0 minutes ago

🗽 New York – Remote

🗽 New York – Remote

💵 $150k - $170k / year

⏰ Full Time

🟠 Senior

👔 Manager

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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

• 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.

🎯 Requirements

• 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

🏖️ 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