Pivotal Health delivers full-service Independent Dispute Resolution (IDR) technology to help providers recover fair reimbursement with less administrative burden. Backed by Bessemer.
About the role
We're looking for a Clinical Subject Matter Expert to own the clinical judgment behind our position statements as we take on more complex facility claims. You'll work side by side with Product and Engineering and shape how our model learns what a persuasive, defensible argument looks like. This role reports directly to our Product Lead. Found on 1752vc Careers, the job board for startup and VC roles.
What they're looking for
- A clinical background, most often nursing, with 5+ years of experience in clinical documentation, denials, or appeals
- Hands-on experience writing or reviewing appeals, denial responses, or clinical arguments meant to persuade a payer, with specific outcomes you can walk us through
- Working knowledge of facility billing, coding, and reimbursement, including how claims, charges, and codes fit together
- Experience giving structured, consistent feedback on written work, such as annotating or scoring drafts against a rubric
- The ability to turn clinical judgment into clear written requirements and criteria that engineers and product managers can act on
- Comfort working inside a product team where processes are still being built, ideally at a startup or technology company
More about this role
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.
We're looking for a Clinical Subject Matter Expert to own the clinical judgment behind our position statements as we take on more complex facility claims. You'll work side by side with Product and...
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