Senior Staff Accountant

Pivotal Health•New York, NY

About The Position

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. About the Role Reporting to our Controller, we’re looking for a Senior Staff Accountant to help build and scale the financial backbone of Pivotal Health. This role will own critical accounting operations, including weekly billing, invoice and expense processing, reconciliations, and many areas of the monthly close, while helping bring structure and predictability to a function that is evolving quickly. Our customer base is expected to grow significantly over the next year, and we need someone who can execute with precision while strengthening the systems underneath the work. You’ll operate with real ownership. This is a role for someone who notices when something doesn’t reconcile, digs into the data until they understand the issue and then recommends a resolution, and isn’t afraid to ask the right questions to protect the integrity of our financial reports. As we implement a new ERP system and prepare for audit, you’ll help move us from “getting it done” to a durable, scalable accounting foundation.

Requirements

5+ years of progressive accounting experience
Bachelor’s degree in Accounting or equivalent hands-on accounting experience with demonstrated mastery of core principles.
Strong understanding of GAAP and core accounting principles
Hands-on experience with NetSuite, Acumatica, or similar ERP systems
Advanced Excel skills (pivot tables, complex formulas, large dataset analysis)
Experienced in monthly close and balance sheet reconciliations
Comfortable working with high volumes of transactional data
Able to communicate clearly with both finance and non-finance stakeholders

Nice To Haves

Experience implementing or optimizing ERP systems
Background in high-growth or fast-paced environments
Exposure to financial audits
Experience automating billing, reporting, or reconciliation workflows

Responsibilities

Own Core Accounting Operations: Take responsibility for weekly customer billing, cash postings, expense report reviews, AP processing, reconciliations, and key components of the monthly close process. Ensure accuracy, timeliness, and consistency across all core workflows.
Build a Predictable Close Process: Help design and strengthen our month-end and year-end processes so we move from reactive processes to a robust and structured full accounting process. Improve documentation, controls, and accountability so we consistently hit deadlines with confidence.
Partner Across the Business: Serve as a trusted partner to Operations, Sales, and FP&A on invoicing, commissions, reconciliations, and reporting. Coordinate directly with cross-functional teams to resolve discrepancies and improve clarity.
Support ERP Implementation and Optimization: Play an active role in implementing and refining our new ERP system. Participate in testing, validation, reporting design, and process improvements to ensure the system supports scale.
Improve Systems and Reduce Manual Work: Identify inefficiencies and areas of risk in current processes. Recommend and implement improvements that increase accuracy, reduce friction, and prepare us for growth and audit readiness.
Prepare Us for Audit & Scale: Help ensure our financial records are well-documented and audit-ready as we prepare for our first financial audit and continued growth.