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Pivotal Health is a technology platform helping healthcare providers navigate complex reimbursement landscapes and dispute underpaid insurance claims through an AI-driven, full-service solution.
You will join the Payor Compliance team as an Accounts Payable Analyst, owning payment processing and refund operations. This role sits at the intersection of data, process, and client impact, requiring you to work directly in Metabase and BigQuery to reconcile payments, identify blockers, and serve as the primary point of contact for refund inquiries.
Key responsibilities:
- Run the weekly refund cycle: Process weekly fee-refund uploads for won or ineligible IDR cases, matching remit amounts precisely against received bricks and escalating discrepancies to Finance. This is a high-volume, detail-heavy cycle processing roughly $2.5M weekly.
- Field refund inquiries: Be the go-to resource for Client Success on refund status questions, using Metabase dashboards and dispute status tools to track and resolve missing or delayed refunds.
- Build and maintain relationships with Independent Dispute Resolution Entities (IDREs) to expedite collection of outstanding refunds owed to practices.
- Drive proactive communication between Client Success, IDREs, Business Operations, and Accounting to ensure alignment.
- Establish and drive new processes to meet evolving business and customer needs.
- Maintain and improve Payor Compliance SOPs as workflows evolve; flag patterns in payment and refund exceptions that indicate systemic issues worth escalating.
- Identify cases where the platform incorrectly marks lost disputes as wins and escalate to engineering with supporting evidence.
This is an excellent opportunity for someone with professional operations experience who enjoys detail-oriented work and wants to develop expertise in payor behavior, healthcare reimbursement, and the No Surprises Act IDR process.
REQUIREMENTS:
- 2–3 years of experience in healthcare operations, revenue cycle, managed care, or related field
- Comfort working directly in data: pulling and interpreting reports in tools like Metabase, BigQuery, or similar; basic SQL is a plus
- Strong written communication skills; you'll regularly write clear explanations of payment and refund issues that Client Success depends on
- Detail-oriented and thorough; ability to follow issues through to resolution, not just flag them
- Organized under volume; able to manage high-volume weekly refund cycles and multiple open payment exceptions simultaneously
- Comfortable working in Excel, Google Sheets, Metabase, or BigQuery to track cases and analyze claims data
- Collaborative mindset; you'll work closely with Payor Compliance and Client Success teams and communicate proactively when blocked or unclear
- Analytical thinker who can evaluate claim and payor data to identify root causes and determine next steps
- Strong data entry accuracy and comfort with detail-heavy, matching-based reconciliation work where amounts must line up exactly
EXTRA CREDIT:
- Familiarity with the No Surprises Act (NSA), federal IDR process, or health insurance payor/TPA structures
- Comfortable working with payment and remittance data (e.g., 835 remits) to reconcile refunds and resolve payment posting exceptions
- Experience with Asana, Notion, Metabase, or similar workflow and reporting tools
- Background in revenue cycle payment posting, refund reconciliation, or 835 remittance processing
- Accounting, bookkeeping, or accounts receivable/payable background
