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Pivotal HealthCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in data management and operational tracking within revenue cycle operations, with a strong focus on medical billing and coding processes. Proficient in managing high volumes of claims while ensuring compliance with state-specific regulations and deadlines.
Highest-signal resume keywords
Data ManagementMedical BillingClaims ManagementExcel ProficiencyState Arbitration Programs
About the role
Key responsibilities & impact- Prepare and submit state dispute and arbitration requests through state portals, agencies, and arbitration entities
- Follow each state’s documentation and formatting requirements
- Track filing and response deadlines
- Process filing fees and confirm payers pay awarded amounts
- Follow up when payments are late or incorrect
- Monitor shared inboxes
- Respond to payers, state agencies, and arbitration entities
- Log next steps for each case
- Update internal systems and spreadsheets with case details and statuses
- Close disputes only once they are fully resolved
- Follow state references for eligibility, deadlines, forms, and fees
- Flag rule changes or gaps so state references remain current
- Notify analytics and product teams when case files are incomplete or inaccurate
- Collaborate with analytics and product teams to keep case data clean
Requirements
What you’ll need- 2–4 years of experience in data management, operational tracking, revenue cycle operations, claims management, or insurance operations
- Experience with medical billing or coding
- Comfortable reading EOBs, claims and reimbursement codes
- Comfortable in Excel or Google Sheets, including pivot tables
- Highly detail-oriented and able to catch inconsistencies in documents and data
- Able to manage high volume and competing deadlines accurately
- Comfortable following detailed, state-specific processes
- Clear written communicator who asks good questions and flags problems early
- Familiarity with the federal No Surprises Act and its interaction with state surprise billing laws
- Prior experience with state arbitration programs, such as New York, New Jersey, or Texas
- Experience with Asana, Metabase, or other project management tools
- Medical billing/coding certification, such as CPC, is extra credit
- Must be authorized to work in the United States without current or future employer sponsorship
- Reside in CST or EST
Benefits
Comp & perks- Competitive compensation, including equity
- Full health, dental, and vision coverage
- Retirement savings plan through 401(k)
- Flexible time off
- Opportunities for company-wide connection and events
- Remote work arrangement
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Data ManagementClaims ManagementMedical BillingEOB ReadingReimbursement CodingOperational TrackingDetail OrientationDeadline ManagementState-Specific ProcessesCase Data Management
Soft Skills
Clear CommunicationProblem-SolvingAttention to DetailCollaborationQuestioning Skills
Tools & Technologies
ExcelGoogle SheetsAsanaMetabase
Certifications & Qualifications
Medical Billing/Coding CertificationCPC
Industry Keywords
Revenue Cycle OperationsNo Surprises ActState Surprise Billing LawsState Dispute ResolutionArbitration Entities