pivotal-health - Analyst, State Dispute Operations
Requirements
• 2–4 years of experience in data management, operational tracking, revenue cycle operations, claims management, or insurance operations • Experience with medical billing or coding, and comfortable reading EOBs, claims and reimbursement codes • Comfortable in Excel or Google Sheets, including pivot tables • Highly detail-oriented, and catches inconsistencies in documents and data • Manages high volume and competing deadlines accurately • Comfortable following detailed, state-specific processes • Clear written communicator who asks good questions and flags problems early • Familiarity with the federal No Surprises Act and how it interacts with state surprise billing laws • Prior experience with state arbitration programs (e.g., New York, New Jersey, Texas) • Experience with tools like Asana or Metabase or other project management tools • Medical billing/coding certification (e.g., CPC)
Responsibilities
• Prepare and submit filings: Enter and submit state dispute and arbitration requests through state portals, agencies and arbitration entities, following each state’s documentation and formatting requirements. • Track deadlines, fees and payments: Monitor filing and response deadlines, process fees and confirm payers pay awarded amounts. Follow up when a payment is late or incorrect. • Manage inbox and correspondence: Monitor shared inboxes, respond to payers, state agencies and arbitration entities, and log next steps for each case. • Keep case records accurate: Update internal systems and spreadsheets with case details and statuses, and close disputes only once they’re fully resolved. • Follow state requirements: Work from state references for eligibility, deadlines, forms and fees, and flag rule changes or gaps so the references stay current. • Flag data issues: Tell our analytics and product teams when a case file is incomplete or inaccurate.
Benefits
• 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. • 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
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