Manager, IDR and Industry Relations

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. WHAT YOU'LL DO IDR SUBJECT MATTER EXPERTISE - Serve as an internal expert on Federal IDR requirements, regulations, guidance, and industry trends - Partner with Client Success and Operations teams to address complex client questions and escalations - Support client meetings where specialized IDR expertise is needed - Develop educational materials and guidance for clients and internal stakeholders - Provide recommendations regarding filing strategy, operational impacts, and emerging regulatory developments IDRE RELATIONSHIP MANAGEMENT - Own strategic relationships with all major IDREs - Conduct recurring business reviews with IDRE partners - Monitor IDRE turnaround times, operational issues, and dispute outcomes - Serve as Pivotal’s primary point of contact for IDRE-related initiatives and opportunities REGULATORY MONITORING & INDUSTRY INTELLIGENCE - Track CMS guidance, Final Rules, FAQs, court decisions, and other developments impacting the No Surprises Act - Translate regulatory changes into operational and product recommendations - Develop summaries and briefings for leadership, clients, and internal teams - Partner with Product and Operations teams to ensure readiness for future regulatory changes INDUSTRY ENGAGEMENT & ADVOCACY - Represent Pivotal in industry associations, conferences, and working groups - Participate in industry discussions regarding NSA implementation and future regulatory developments - Help strengthen Pivotal’s reputation as a thought leader within the IDR space INTERNAL ENABLEMENT - Deliver ongoing education and training to Client Success, Operations, and Product teams - Build and maintain a centralized repository of IDR guidance and best practices - Create recurring updates highlighting industry trends and regulatory changes - Support onboarding and training of new team members WHO YOU ARE - Deep familiarity with the No Surprises Act and Federal IDR process - Experience working with healthcare providers, payors, IDREs, or organizations supporting the Federal IDR ecosystem - Strong written and verbal communication skills - Experience managing external stakeholder relationships - Ability to interpret complex regulatory information and communicate it clearly to different audiences - Highly organized and comfortable managing multiple priorities - Experience working directly with CMS-related programs or IDRE organizations - Experience presenting educational content, webinars, conferences, or industry forums - Healthcare operations, reimbursement, or dispute resolution experience - Existing relationships within the Federal IDR ecosystem 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.