Pivotal Health
Optimization Analyst
Lower Manhattan, NY · Contract
No sponsorshipDetected 16 days ago
SQLData VisualizationExcel
About the role
- We're looking for an Optimization Analyst to help with our fast growing team!
- Our Payor Optimization team sits between our clients, Client Success, and payors-working to ensure providers receive accurate and timely reimbursement following IDR determinations.
- Our rapidly growing business is hiring an analyst to triage CS escalations and close the loop on claims that need follow-through.
Responsibilities
- You'll own the daily flow of the Asana Payor Compliance queue, dig into the client and payor situations CS flags, and pull claims data from Metabase to uncover the real root cause.
- Lead deep-dive payor reviews: You'll investigate payors to find what's actually blocking payment, whether it's routing issues, INN processing, or eligibility gaps. Then you'll document what you learn and communicate a plan through data storytelling.
- Shape the playbook: You'll build CS-facing materials, sharpen our SOPs as workflows evolve, and spot the patterns that turn into bigger wins. Around here, small, consistent wins compound, and you'll be the one stacking them.
- People energize you. You're warm, personable, and quick to build trust, with genuine customer-service instincts in every conversation with CS and payors.
- 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.
Nice to have
- Excel is home turf, pivot tables included.
- People energize you.
- You write with clarity and confidence.
- Your findings and rationale become the language CS takes straight to clients.
- SQL, data storytelling, or dashboard know-how in Metabase, Power BI, or similar
- Comfort with Asana, Notion, or similar workflow tools
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.
- You've spent 1 to 3 years in healthcare operations, revenue cycle, managed care, consulting (highly preferred), or an analyst role in finance or healthcare.
- Familiarity with the No Surprises Act, the NSA IDR process, or health insurance TPA/payor structures
Company info
- You'll partner closely with the Payor Optimization Strategist and a genuinely strong Client Success org, at a company invested in developing its analysts.
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.