Optimization Analyst

Pivotal Health•New York, NY

3d•$85,000 - $105,000•Hybrid

About The Position

Pivotal Health is seeking an Optimization Analyst to join their fast-growing team. The Payor Optimization team works between clients, Client Success, and payors to ensure providers receive accurate and timely reimbursement after IDR determinations. This role involves triaging client success escalations and following up on claims that require further action. The position offers a unique opportunity to work in a rapidly scaling business with greenfield processes, allowing the analyst to directly influence the development of payor compliance strategies. The company will provide training on the IDR process, but seeks candidates with inherent curiosity, data instincts, and strong interpersonal skills.

Requirements

1 to 3 years of experience in healthcare operations, revenue cycle, managed care, consulting, or an analyst role in finance or healthcare.
Proficiency in Excel, including pivot tables.
Strong interpersonal skills with a warm, personable demeanor and the ability to build trust quickly.
Genuine customer-service instincts for interactions with Client Success and payors.
Excellent written communication skills with clarity and confidence.
Detail-oriented and organized, capable of managing high volumes and following through on tasks.
Ability to work independently and manage multiple reviews simultaneously.

Nice To Haves

Familiarity with the No Surprises Act, the NSA IDR process, or health insurance TPA/payor structures.
Experience with SQL, data storytelling, or dashboard creation in tools like Metabase or Power BI.
Comfort using workflow tools such as Asana or Notion.

Responsibilities

Serve as the primary point of contact for Client Success regarding payor compliance questions, managing tickets and participating in calls.
Own the daily workflow of the Asana Payor Compliance queue, investigating client and payor situations flagged by Client Success.
Extract and analyze claims data from Metabase to identify root causes of payment issues.
Conduct in-depth reviews of payors to identify payment barriers such as routing issues, INN processing, or eligibility gaps.
Document findings from payor reviews and communicate action plans through data storytelling.
Act as the initial point of contact for payor outreach campaigns, preparing emails, managing payor inboxes, and tracking responses.
Maintain the Payor Outreach Tracker with up-to-date information at every milestone.
Develop Client Success-facing materials and refine Standard Operating Procedures (SOPs) as workflows evolve.
Identify patterns and trends that can lead to larger process improvements and wins.