IDR Analyst (Federal and State)

Pivotal Health•New York, NY

2d•$55,000 - $65,000•Remote

About The Position

Pivotal Health is seeking an IDR Analyst to support healthcare dispute resolution workflows, including Independent Dispute Resolution (IDR) processes. The role involves managing dispute cases through arbitration, ensuring accurate review, submission, and tracking of claims. This position is part of a dispute operations team handling both federal and state-level reimbursement disputes. The work requires strong attention to detail and analytical thinking to evaluate eligibility and documentation. The analyst will collaborate with internal teams and external partners like IDREs and state arbitration entities to ensure disputes meet regulatory guidelines and progress successfully through arbitration. This is an opportunity for individuals with professional experience in detail-oriented operational work to develop expertise in healthcare reimbursement and regulatory processes. Depending on the focus (federal IDR or state-specific disputes), the role may involve building fluency in established workflows or independently researching and translating state laws, regulations, and procedures into clear instructions and workflows for the team. The ideal candidate is curious, digs deeper when needed, and takes ownership of process management in an industry where accuracy is critical for timely reimbursement.

Requirements

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

Nice To Haves

Familiarity with Independent Dispute Resolution (IDR), arbitration, or healthcare regulatory workflows
Experience working with operational tools such as Asana, Metabase, or similar systems
Medical billing/coding certification (e.g., CPC) or other formal coding training
Knowledge of state-level IDR regulations in addition to federal requirements

Responsibilities

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.