IDR Analyst: Federal & State Reimbursement

Pivotal Health; New York (NY); Hybrid; USD 55,000 - 65,000; Full time

Benefits offered by this job

Competitive compensation, including EQ

Full health, dental, and vision

Retirement savings plan through 401(k)

Flexible time off

Company-wide connection and events

Job summary

Pivotal Health is seeking an IDR Analyst to support healthcare dispute resolution workflows, handling dispute cases through arbitration and ensuring accurate submission, review, and tracking. You will work with federal IDR processes and state disputes, requiring careful attention to regulatory guidance and documentation.

Join a broader dispute operations team and develop expertise in reimbursement workflows, with opportunities to own parts of federal or state processes, depending on focus.

Qualifications

• 2–4 years of experience in revenue cycle operations, claims management, or reimbursement/insurance operations.
• Experience with medical billing or coding; comfortable reading EOBs, claims, and reimbursement codes.
• Comfortable working in Excel or Google Sheets, including building and using pivot tables, to track cases and data.
• Strong attention to detail and analytical thinking; ability to review documentation, catch inconsistencies, and determine next steps.
• Ability to manage a high volume of competing deadlines with strong written communication.
• Comfortable exercising judgment and asking thoughtful questions rather than waiting for every next step to be prescribed; able to make well-supported recommendations and grow into more independent ownership of your day to day

Responsibilities

• Evaluate dispute eligibility and documentation: Analyze claim information to ensure cases meet federal IDR or state-specific dispute requirements before submission.
• Research and interpret state regulatory requirements: For state-specific work, independently research state laws, regulations, agency guidance, payer requirements, and arbitration procedures; interpret how they apply operationally; and translate that research into clear, reliable instructions and workflows for the rest of the team.
• Own inbox and correspondence review: Monitor shared inboxes and respond to incoming emails from payors and IDR entities, tracking follow-ups and next steps for each case.
• Ensure accurate case closures: Confirm disputes are closed only when truly resolved, catching premature or missed closures before they affect reimbursement.
• Monitor arbitration timelines and correspondence: Track deadlines and review communications from health plans, arbitration entities, and internal teams to ensure cases progress appropriately.
• Maintain operational tracking and documentation: Update internal systems and spreadsheets to maintain accurate case records, dispute statuses, and operational metrics.
• Support operational improvements: Contribute to refining workflows and documentation as the team builds more scalable dispute management processes, and flag documentation or system issues to our analytics and product teams when case files are incomplete or inaccurate.

Skills

IDR / dispute workflows

Revenue cycle experience

Excel / Google Sheets

Attention to detail

Written communication

Independent ownership

Tools

Asana

Metabase

Job description

Pivotal Health is seeking an IDR Analyst to support healthcare dispute resolution workflows, handling dispute cases through arbitration and ensuring accurate submission, review, and tracking. You will work with federal IDR processes and state disputes, requiring careful attention to regulatory guidance and documentation.

Join a broader dispute operations team and develop expertise in reimbursement workflows, with opportunities to own parts of federal or state processes, depending on focus.