Manager, IDR and Industry Relations

Pivotal Health; New York (NY); Hybrid; USD 140,000 - 190,000; Full time

Benefits offered by this job

Competitive pay

Health, dental, vision

401(k)

Flexible PTO

Team events

Job summary

Pivotal Health is seeking an IDR Subject Matter Expert to lead regulatory and dispute-resolution efforts for federal IDR programs. You will translate complex No Surprises Act guidance into actionable recommendations for clients and internal teams.

In this role, you will manage external stakeholder relationships, monitor regulatory developments, and contribute to education materials and product strategy across IDR workflows.

Qualifications

• Deep familiarity with the No Surprises Act and Federal IDR process.
• Experience working with healthcare providers, payors, or IDREs.
• Strong written and verbal communication skills.
• Ability to interpret regulatory information and communicate clearly.

Responsibilities

• Serve as an internal expert on Federal IDR requirements, regulations, guidance, and trends.
• Partner with Client Success and Operations to address complex client questions.
• Support client meetings where IDR expertise is needed.
• Develop educational materials and guidance for clients and internal stakeholders.
• Provide recommendations on filing strategy and regulatory developments.
• Own strategic relationships with major IDREs and conduct business reviews.
• Monitor IDRE turnaround times and dispute outcomes.
• Translate CMS guidance into operational recommendations.
• Develop summaries and briefings for leadership and clients.
• Represent Pivotal in industry associations and forums.
• Deliver ongoing education and training to teams.

Skills

No Surprises Act

Federal IDR knowledge

Regulatory interpretation

Stakeholder management

Written communication

Verbal communication

Job description

About Pivotal Health

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. 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.

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.

Our full‑service IDR solution is just the starting point. We’re building solutions that enable providers to operate with clarity, control, and confidence across the reimbursement journey.

What You’ll Do

IDR Subject Matter Expertise

• Serve as an internal expert on Federal IDR requirements, regulations, guidance, and industry trends

• Partner with Client Success and Operations teams to address complex client questions and escalations

• Support client meetings where specialized IDR expertise is needed

• Develop educational materials and guidance for clients and internal stakeholders

• Provide recommendations regarding filing strategy, operational impacts, and emerging regulatory developments

IDRE Relationship Management

• Own strategic relationships with all major IDREs

• Conduct recurring business reviews with IDRE partners

• Monitor IDRE turnaround times, operational issues, and dispute outcomes

• Serve as Pivotal’s primary point of contact for IDRE‑related initiatives and opportunities

Regulatory Monitoring & Industry Intelligence

• Track CMS guidance, Final Rules, FAQs, court decisions, and other developments impacting the No Surprises Act

• Translate regulatory changes into operational and product recommendations

• Develop summaries and briefings for leadership, clients, and internal teams

• Partner with Product and Operations teams to ensure readiness for future regulatory changes

Industry Engagement & Advocacy

• Represent Pivotal in industry associations, conferences, and working groups

• Participate in industry discussions regarding NSA implementation and future regulatory developments

• Help strengthen Pivotal’s reputation as a thought leader within the IDR space

Internal Enablement

• Deliver ongoing education and training to Client Success, Operations, and Product teams

• Build and maintain a centralized repository of IDR guidance and best practices

• Create recurring updates highlighting industry trends and regulatory changes

• Support onboarding and training of new team members

Who You Are

• Deep familiarity with the No Surprises Act and Federal IDR process

• Experience working with healthcare providers, payors, IDREs, or organizations supporting the Federal IDR ecosystem

• Strong written and verbal communication skills

• Experience managing external stakeholder relationships

• Ability to interpret complex regulatory information and communicate it clearly to different audiences

• Highly organized and comfortable managing multiple priorities

• Experience working directly with CMS‑related programs or IDRE organizations

• Experience presenting educational content, webinars, conferences, or industry forums

• Healthcare operations, reimbursement, or dispute resolution experience

• Existing relationships within the Federal IDR ecosystem

Why You’ll Love Working Here

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.

Benefits Include:

• 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

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

Pivotal Health provides reasonable accommodations for qualified individuals with disabilities in accordance with applicable laws. If you need assistance during the application or interview process, please let us know.

Background Checks

Employment is contingent upon successful completion of applicable background checks, where permitted by law.

At‑Will Employment

Employment with Pivotal Health is at‑will and may be terminated by either party at any time, with or without cause or notice, in accordance with applicable law.