IDR Analyst – Federal and State

Pivotal Health

IDR Analyst managing dispute resolution workflows for Pivotal Health. Evaluating claims and ensuring compliance with regulatory guidelines in healthcare reimbursement processes.

Posted 7/23/2026full-timeRemote • New York • 🇺🇸 United StatesJuniorMid-Level💰 $55,000 - $65,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in revenue cycle operations and claims management, with a strong focus on analyzing dispute eligibility and ensuring compliance with state and federal regulations. Proficient in operational tracking and documentation, with a commitment to improving workflows and maintaining accurate case records.

Highest-signal resume keywords

Revenue Cycle OperationsClaims ManagementMedical BillingExcel ProficiencyAnalytical Thinking

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Dispute Eligibility EvaluationClaims AnalysisEOB ReadingReimbursement CodingOperational TrackingDocumentation MaintenanceWorkflow RefinementData AnalysisCase Closure VerificationRegulatory Research

Soft Skills

Attention to DetailStrong Written CommunicationJudgmentAnalytical ThinkingTime Management

Tools & Technologies

ExcelGoogle Sheets

Industry Keywords

IDRPayer RequirementsArbitration ProceduresHealth PlansReimbursement

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

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

Benefits

Comp & perks

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