Healthcare Revenue Optimization Analyst

Alt; Williamsburg (VA); Hybrid; USD 70,000 - 95,000; Full time

Job summary

Pivotal Health is seeking an Optimization Analyst to join our Upstream Eligibility team. You’ll be the first line of intake for payor eligibility inquiries and help ensure eligible claims are processed correctly.

You’ll balance data review with cross-functional collaboration to reduce waste and improve client outcomes. You’ll stand up an ineligible claims review process, build dashboards, and shape the playbook for how eligibility is communicated to clients.

Qualifications

• 1 to 3 years in healthcare operations or related roles.
• Strong Excel skills with pivot tables; basic SQL capability.
• Excellent communication and customer-service orientation.
• Ability to work across teams and with product and CS.

Responsibilities

• Be the go-to for Client Success and handle eligibility inquiries.
• Run the ineligible claims review and determine outcomes.
• Document patterns and work with Product to fix root causes.
• Shape the playbook and create CS-facing materials on eligibility.
• Own the eligibility-risk dashboards in Metabase or Power BI.

Skills

Healthcare operations

SQL basics

Customer-facing

Cross-functional collaboration

Tools

Metabase

Power BI

Excel

Asana

Notion

Job description

Pivotal Health is seeking an Optimization Analyst to join our Upstream Eligibility team. You’ll be the first line of intake for payor eligibility inquiries and help ensure eligible claims are processed correctly.

You’ll balance data review with cross-functional collaboration to reduce waste and improve client outcomes. You’ll stand up an ineligible claims review process, build dashboards, and shape the playbook for how eligibility is communicated to clients.