IDR Analyst (Federal and State)

Job description

ABOUT PIVOTAL HEALTH Pivotal Health is the leading technology platform that helps healthcare providers get paid fairly in an increasingly complex reimbursement landscape. Today, many providers face persistent underpayment from health insurance companies, despite delivering high-quality care. While processes like IDR (Independent Dispute Resolution) were designed to promote fairness, they’re often administrative-heavy, time-consuming, and difficult to navigate without the right tools. Pivotal Health combines software, data, and service into a seamlessly integrated, AI-driven platform that simplifies these complex reimbursement workflows. We help providers efficiently dispute underpaid claims, reduce administrative burden, and recover the reimbursement they’re entitled to; without adding more work to already stretched teams. Our full-service IDR solution is just the starting point. We’re building solutions that enable providers to operate with clarity, control, and confidence across the reimbursement journey. About the Role We’re looking for an IDR Analyst to support Pivotal’s healthcare dispute resolution workflows, including Independent Dispute Resolution (IDR) processes. In this role, you’ll manage dispute cases through the arbitration process, ensuring claims are reviewed, submitted, and tracked accurately. This role sits within a broader dispute operations team that owns both federal and state-level reimbursement disputes, and your assigned area may include federal IDR processes, state-specific dispute and arbitration processes, or both. Regardless of focus, the work requires strong attention to detail and analytical thinking to evaluate eligibility, documentation, and case requirements. You’ll work closely with internal teams and external partners — such as IDREs (Independent Dispute Resolution Entity) for federal cases, or the relevant state arbitration entities and agencies for state cases — to ensure disputes meet the applicable regulatory guidelines and progress through the arbitration process successfully. This is a great opportunity for someone with professional experience who enjoys detail-oriented operational work and wants to develop deep expertise in healthcare reimbursement and regulatory processes. If your focus is federal IDR, you’ll build fluency in our established workflows and steadily take on more independent judgment calls and a real say in how the process evolves. If your focus includes state-specific disputes, the bar is higher from the start: state programs vary widely, so you’ll need to independently research the relevant state laws, regulations, agency guidance, payer requirements, and arbitration procedures, figure out how they apply operationally, and turn that research into clear, reliable instructions and workflows the rest of the team can follow. Either way, we’re looking for someone who stays curious, digs deeper when something doesn’t add up, and takes real ownership of how the process runs — in an industry where a single missing detail can delay a provider’s reimbursement What You’ll Do - 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. Who You Are - 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 Extra Credit Experience - Familiarity with Independent Dispute Resolution (IDR), arbitration, or healthcare regulatory workflows - Experience working with operational tools such as Asana, Metabase, or similar systems - Medical billing/coding certification (e.g., CPC) or other formal coding training - Knowledge of state-level IDR regulations in addition to federal requirements WHY YOU’LL LOVE WORKING HERE We’re a collaborative, low-ego team on a mission to make healthcare reimbursement fairer for providers. While we primarily hire around our core hubs–Los Angeles and New York–we remain open to exceptional talent outside those regions. Remote and hybrid flexibility varies by role and team, and is outlined in each job description. If you’re excited by solving complex problems and making a real-world impact, we’d love to hear from you. Benefits Include: - 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 Ready to Make an Impact? We’re building something meaningful; and we want you on the team. Bring your ideas, curiosity, and drive, and let’s transform healthcare reimbursement together. EMPLOYMENT INFORMATION Work Authorization Candidates must be authorized to work in the United States without current or future employer sponsorship. Equal Employment Opportunity Pivotal Health is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate on the basis of race, color, religion, sex, gender identity or expression, sexual orientation, national origin, age, disability, veteran status, or any other legally protected status. Reasonable Accommodations Pivotal Health provides reasonable accommodations for qualified individuals with disabilities in accordance with applicable laws. If you need assistance during the application or interview process, please let us know. Background Checks Employment is contingent upon successful completion of applicable background checks, where permitted by law. At-Will Employment Employment with Pivotal Health is at-will and may be terminated by either party at any time, with or without cause or notice, in accordance with applicable law.