Healthcare Reimbursement Optimization Analyst

Alt; New York, Northern (NY, KY); Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

Competitive compensation

Equity

Full health, dental, and vision

401(k) retirement plan

Flexible time off

Company-wide events

Job summary

Pivotal Health is seeking an Optimization Analyst to join the Upstream Eligibility team. You’ll be the first Optimization Analyst, owning intake for payor eligibility inquiries and helping stand up an ineligible-claims review process.

You’ll partner with CS, Product, and Legal to tighten eligibility workflows, build dashboards in Metabase/Power BI, and translate data into client guidance. This role blends analytics with process design and cross-team collaboration.

Qualifications

• 1–3 years in healthcare operations, revenue cycle, or an analyst role in finance or healthcare.
• Strong Excel and pivot-table skills; ability to write basic SQL or use AI tools to draft it and verify results.
• Clear communicator with customer-service instincts and cross-team collaboration.

Responsibilities

• Be the go-to for Client Success on eligibility questions and intake for payor inquiries.
• Run the ineligible claims review and determine truly ineligible vs. default corrections or disputes.
• Document patterns and work with Product to fix root causes once, not per claim.
• Shape CS-facing playbooks on IDR eligibility and escalation paths.
• Own the eligibility-risk dashboards in Metabase or Power BI.

Skills

Excel

Pivot tables

SQL

Data storytelling

AI tools

Tools

Power BI

Metabase

Asana

Notion

Job description

Pivotal Health is seeking an Optimization Analyst to join the Upstream Eligibility team. You’ll be the first Optimization Analyst, owning intake for payor eligibility inquiries and helping stand up an ineligible-claims review process.

You’ll partner with CS, Product, and Legal to tighten eligibility workflows, build dashboards in Metabase/Power BI, and translate data into client guidance. This role blends analytics with process design and cross-team collaboration.