Pivotal Health एक हेल्थकेयर टेक्नोलॉजी कंपनी है, जो अस्पतालों और विशेषज्ञ चिकित्सा संस्थानों को एकीकृत स्वतंत्र विवाद समाधान (IDR) प्लेटफ़ॉर्म के माध्यम से उचित प्रतिपूर्ति प्राप्त करने में मदद करती है। इसका SaaS समाधान वर्कफ़्लो ऑटोमेशन, डेटा और प्रबंधित सेवाओं को जोड़कर पात्रता जाँच, सबमिशन और अपील की प्रक्रिया में सहायता करता है तथा प्रमुख रेवेन्यू साइकिल मैनेजमेंट प्रणालियों से जुड़ता है। Pivotal Health पूरी प्रक्रिया के दौरान व्यावहारिक सहयोग भी प्रदान करती है और परिणाम-आधारित मॉडल अपनाती है, जिसमें ग्राहक सफल परिणाम मिलने के बाद भुगतान करते हैं। कंपनी का कार्य प्रदाता संगठनों के लिए राजस्व वसूली, पारदर्शिता और परिचालन दक्षता में सुधार पर केंद्रित है।
Healthcare Eligibility Optimization Analyst at Pivotal Health - Hybrid
Analyze healthcare claim eligibility for Pivotal Health’s AI-powered reimbursement platform. Develop review workflows, corrective actions, client guidance, and risk dashboards.
विवरण
- Support Client Success as the primary resource for eligibility questions across tickets, calls, and payor outreach
- Receive and triage incoming payor eligibility inquiries
- Analyze claims data to uncover underlying causes
- Assess payor, internal, and IDRE eligibility flags to distinguish genuine ineligibility, correctable product defaults, and disputable payor decisions
- Provide Client Success with clear eligibility conclusions
- Track recurring default-ineligible patterns and partner with Product on fixes
- Create Client Success resources covering IDR eligibility and payor-specific responses
- Establish workflows and escalation paths for disputed flags, including payor contact and legal escalation
- Develop and maintain eligibility-risk dashboards in Metabase or Power BI
- Track recurring issues and surface eligibility risks before filings are submitted
- Create the ineligible-claims review workflow and help move detection from reactive to proactive
आवश्यकताएँ
- 1–3 years of experience in healthcare operations, revenue cycle, managed care, consulting, or an analyst position in finance or healthcare
- Proficiency with Excel, including pivot tables
- Ability to write basic SQL or use an AI tool to draft and validate SQL queries
- Warm, approachable, and customer-focused communication style
- Strong, confident written communication
- Highly organized and attentive to detail when managing high volumes
- Ability to collaborate effectively across teams
- Knowledge of the No Surprises Act, IDR eligibility requirements, or health plan structures is a plus
- Advanced SQL, data storytelling, or dashboard experience with Metabase, Power BI, or similar tools is a plus
- Familiarity with Asana, Notion, or comparable workflow tools is a plus
- Authorized to work in the United States without current or future employer sponsorship
लाभ
- Equity participation
- Comprehensive health, dental, and vision coverage
- 401(k) retirement savings plan
- Flexible paid time off
- Company-wide connection and event opportunities
- Remote and hybrid work arrangements vary by role and team