Pivotal Health
Senior Manager, State IDR
Lower Manhattan, NY · Senior · Contract
No sponsorshipDetected 12 days ago
SQLData AnalysisProduct ManagementProduct StrategyExcelLeadership
About the role
- State arbitration is a growing and increasingly important part of our business, and it has reached the point where it needs a dedicated leader driving strategy, operations, and execution.
- You'll also need to get comfortable in the weeds of remittance advice and eligibility determination, since untangling federal versus state process is a real part of the job.
- The person who thrives here is a strategic thinker who's also willing to be an architect.
Responsibilities
- 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.
- A track record of walking into ambiguity and building structure
- Own state arbitration strategy end to end.
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
- Working knowledge of the payor landscape, state arbitration, and IDR entities
Nice to have
- Comfortable with Excel and data analysis
- SQL and AI tooling experience is a strong plus
Compensation
- Competitive compensation, including equity
Benefits
- Competitive compensation, including equity
- Full health, dental, and vision coverage
- Retirement savings plan through 401(k)
- Flexible time off
- 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.
- 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.
- We're building solutions that enable providers to operate with clarity, control, and confidence across the reimbursement journey.
Equal 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
Visa & Work Authorization
- Candidates must be authorized to work in the United States without current or future employer sponsorship.
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This listing is sourced directly from Pivotal Health's careers page and normalized into a canonical job model.