Analyst, State Dispute Operations
New
P
Pivotal HealthHealthcare reimbursement
Remote - USFull-TimeMiddle
Salary$26 – $30 per hour
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Job Details
- Experience
- 2–4 years of experience in data management, operational tracking, revenue cycle operations, claims management, or insurance operations
- Required Skills
- Microsoft ExcelGoogle SheetsData management
Requirements
- Have 2–4 years of experience in data management, operational tracking, revenue cycle operations, claims management, or insurance operations.
- Have experience with medical billing or coding.
- Be comfortable reading EOBs, claims, and reimbursement codes.
- Be comfortable using Excel or Google Sheets, including pivot tables.
- Be highly detail-oriented and able to catch inconsistencies in documents and data.
- Manage high volume and competing deadlines accurately.
- Be comfortable following detailed, state-specific processes.
- Communicate clearly in writing, ask questions, and flag problems early.
- Familiarity with the federal No Surprises Act and its interaction with state surprise billing laws is a plus.
- Prior experience with state arbitration programs, such as New York, New Jersey, or Texas, is a plus.
- Experience with Asana, Metabase, or other project management tools is a plus.
- Medical billing or coding certification, such as CPC, is a plus.
Responsibilities
- Prepare and submit state dispute and arbitration requests through state portals, agencies, and arbitration entities.
- Follow each state's documentation and formatting requirements for filings.
- Monitor filing and response deadlines, process fees, and confirm payers pay awarded amounts.
- Follow up when a payment is late or incorrect.
- Monitor shared inboxes, respond to payers, state agencies, and arbitration entities, and log next steps for each case.
- Update internal systems and spreadsheets with case details and statuses, and close disputes only once fully resolved.
- Use state references for eligibility, deadlines, forms, and fees, and flag rule changes or gaps.
- Tell analytics and product teams when a case file is incomplete or inaccurate.
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