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Williamsburg, Kentucky, United States
Hybrid
Not Available
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.
Pivotal Health is looking for an IDRE Manager to own and professionalize the relationships that sit at the center of our arbitration and reimbursement operations. Independent Dispute Resolution Entities (IDREs) are CMS-approved intermediaries in the No Surprises Act arbitration process, and Pivotal Health currently manages 16+ of these relationships across both federal and state-level arbitration. Today, engagement with IDREs is fragmented; this role will build the structure, cadence, and escalation process needed to manage those relationships proactively rather than reactively.
This is a highly relational, highly organized role. You'll be the person who knows exactly where every dispute sits in the aging cycle, which IDREs are falling out of compliance, and how to get movement, while also translating what you're seeing on the ground into clear, digestible input for Ops, Product, and Engineering so the business can close gaps and improve its processes over time.
Own and manage direct relationships with 16+ IDREs, serving as the primary point of contact for escalations, disputes, and day-to-day coordination
Build and run the process for tracking dispute aging, flagging CMS compliance issues (e.g., payment timelines), and escalating with the right IDRE at the right time
Manage a high volume of concurrent IDRE relationships at both the individual case level and the portfolio level
Translate patterns and issues surfaced through IDRE relationships into clear, actionable input for Ops, Product, and Engineering teams; identify gaps, recommend fixes, and propose interim stopgaps while longer-term solutions are built
Work across both state and federal arbitration processes, including IDREs that operate in both
Align internal goals and opportunities to client needs, and help ensure Pivotal Health's approach to IDRE management scales as engagement volume grows
Bring structure, prioritization frameworks (e.g., stack-ranking disputes by age, value, IDRE friendliness, and win/loss rate), and consistent process to a function that is still being built from the ground up
Serve as the IDR & Pivotal operations subject-matter expert in external-facing moments: support complex client questions and escalations, join client meetings that need specialized expertise, develop client education and filing-strategy guidance, and run recurring business reviews with IDRE partners.
Background in revenue cycle management (RCM), healthcare, or management consulting
Experience managing multiple concurrent client or vendor engagements/portfolios simultaneously
Strong relationship management skills. This role is fundamentally relational, not just technical
Comfort with Excel and working with operational/dispute data sets
Strong project and portfolio management skills, with the organizational rigor to track disputes, aging, and escalations across many relationships at once
A get-it-done, feedback-oriented approach that fits a fast-growing, still-forming function
Ability to distill complex, on-the-ground issues into clear recommendations for cross-functional teams
Flexibility to travel occasionally for client meetings and company offsite meetings (approximately 4-5x per year)
Regulatory familiarity, with the ability to help design or adapt programs to fit evolving requirements
Experience managing executive level relationships (i.e. C-Suite stakeholders)
Knowledge of Federal IDR requirements, regulations, guidance, and industry trends
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.
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.
