Facility Billing Specialist

Pivotal Health

. Serve as the facility billing authority for inpatient and outpatient facility claims in IDR .

Posted 10/15/2026full-timeUnited StatesSeniorLead💰 $170,000 - $220,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive expertise in hospital revenue cycle management, including inpatient and outpatient reimbursement methodologies, and the ability to translate complex billing knowledge into actionable product requirements. Proven track record in leading cross-functional initiatives and writing persuasive appeals and negotiation memos.

Highest-signal resume keywords

10+ Years In Revenue Cycle ManagementInpatient Reimbursement ExpertiseOutpatient Reimbursement ExpertiseExperience With 837I And 835 FilesAbility To Write Product Requirements

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AnalysisPayer NegotiationEvidence-Based Appeals WritingAdjustment Logic InterpretationRevenue Code FluencyHCPCS/CPT KnowledgeICD-10-CM/PCS FamiliarityMS-DRG / APR-DRG KnowledgeAPC/OPPS UnderstandingBundled Payments Analysis

Soft Skills

Cross-Functional LeadershipEffective CommunicationPersuasive WritingProblem SolvingStakeholder Management

Industry Keywords

HealthTechPayer ContractingDenials RecoveryNo Surprises ActIDRSurprise-Billing ArbitrationChargemaster KnowledgeUnderpayment RecoveryHospital Revenue CycleManaged Care

About the role

Key responsibilities & impact

Serve as the facility billing authority for inpatient and outpatient facility claims in IDR
Define how Pivotal evaluates, prices, and presents facility claims
Decide which claim types to accept first and which to turn away
Own the expansion plan, owners, dependencies, and timeline across product, engineering, data, operations, client success, sales, and legal/compliance
Communicate status and risks to leadership and escalate early
Translate facility-billing and IDR knowledge into product requirements for 837I/835 ingestion and parsing, claim-level versus line-level logic, DRG, revenue code and HCPCS handling, batching rules, and QPA analysis
Build frameworks and templates for facility offers and arbitration briefs
Present case mix, acuity, scope of services, teaching status, market position, and prior contracted rates
Respond to payer QPA
Analyze 837I and 835 data, including CARC/RARC codes, adjustments, bundled payments, outliers, and carve-outs
Identify underpayment patterns and determine which claims are worth disputing
Join sales conversations and client onboarding with hospital revenue cycle, managed care, and finance leaders
Maintain credibility with CFOs and patient financial services teams

Requirements

What you’ll need

10+ years in hospital or health-system revenue cycle, managed care or payer contracting, reimbursement, or denials/underpayment recovery
Hands-on institutional claims experience
Working command of inpatient reimbursement: MS-DRG / APR-DRG, per diem, case rates, and outliers
Working command of outpatient reimbursement: APC/OPPS, fee schedules, percent-of-charge, and packaging
Fluency with revenue codes, HCPCS/CPT, ICD-10-CM/PCS, UB-04, and bill types
Fluency with 837I and 835 files, including adjustment logic and remit interpretation
Direct experience with the No Surprises Act, IDR, or payer disputes over out-of-network facility reimbursement, or ability to ramp fast
Ability to write persuasive, evidence-based appeals, payer negotiation memos, and arbitration briefs
Track record of leading cross-functional work without formal authority
Experience writing sharp product requirements
Experience operating in a startup or scale-up environment
Must be authorized to work in the United States without current or future employer sponsorship
HealthTech or healthcare-related technology experience is extra credit
Experience at an IDR entity, payer QPA/OON pricing team, or underpayment-recovery firm is extra credit
Contract modeling or chargemaster knowledge and familiarity with state surprise-billing arbitration programs are extra credit

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 and hybrid flexibility varies by role and team