Pivotal Health este o companie de tehnologie medicală care ajută spitalele și cabinetele de specialitate să obțină rambursări echitabile printr-o platformă integrată pentru soluționarea independentă a disputelor (IDR). Soluția sa SaaS combină automatizarea fluxurilor de lucru, datele și serviciile gestionate pentru a sprijini verificarea eligibilității, depunerea solicitărilor și contestațiile, conectându-se totodată la principalele sisteme de gestionare a ciclului veniturilor. Pivotal Health oferă, de asemenea, asistență practică pe tot parcursul procesului și utilizează un model aliniat la rezultate, în care clienții plătesc după obținerea unor rezultate favorabile. Activitatea companiei se concentrează pe îmbunătățirea recuperării veniturilor, a transparenței și a eficienței operaționale pentru organizațiile furnizoare de servicii medicale.
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.
Descriere
- 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
Cerințe
- 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
Beneficii
- 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