Analysis Skills, Auditing, Content Management Systems (CMS), Corrective Action, Documentation, Healthcare, Maintain Compliance, Medical Billing, National Committee for Quality Assurance (NCQA), Ontology, Operational Audit, Payment Processing, Regulations, Regulatory Compliance, Reporting Skills, Utilization Review Accreditation Commission (URAC)
Provider Resources Inc. (PRI) is looking for a Manager of Compliance Audit to own our IDR determination audit function. This is an individual contributor role for a compliance professional with deep IDR and No Surprises Act knowledge who can audit case-level determinations, identify systemic patterns, and drive corrective action in a fast-scaling, CMS-regulated environment.
What you will do:
*Audit IDR operational determinations for accuracy, consistency, and CMS regulatory compliance
*Identify patterns across reviewers, case types, and program lines and escalate systemic findings
*Maintain audit documentation and findings reports to URAC and CMS standards
*Track findings through CAPA to resolution
*Support external URAC and CMS audit preparation
What we are looking for:
*5 to 8 years compliance or auditing experience in a healthcare or regulated environment
*Direct knowledge of the IDR process, No Surprises Act, and CMS IDR regulations - IDRE or IRO experience preferred
*Experience conducting structured compliance audits and producing findings reports
*Analytical - comfortable identifying patterns across large case volumes
*URAC or NCQA audit familiarity preferred
Why PRI:
*Meaningful work - PRI processes payment disputes that directly protect patients from unexpected medical bills under the No Surprises Act
*Growth stage - we are building the systems, processes, and team that will define PRI for the next decade
*Skills framework - every role at PRI has a defined skills ontology with clear growth paths and Udemy development pathways
*Lean and direct - decisions get made, work is visible, and contributions matter
PRI is an equal opportunity employer. We evaluate candidates on demonstrated skills and capability.P
Provider Resources
Provider Resources, Inc.
Corporate Capabilities StatementPRI is an growing and dynamic equal opportunity employer that is driven by a diverse and dedicated team of experts. We invite individuals throughout the United States who share our mission, values, and passion to review the opportunities our company provides.
Mission Statement Provider Resources, Inc., recognizing the complexity of healthcare, is dedicated to supporting the healthcare community with compliance and integrity issues through education and efficient, innovative processes.
Value Statement In pursuit of our mission, we must always be mindful of the values each and every one of us must impart as individuals and together are the spirit of Provider Resources, Inc. Our values must be soundly based upon the principles of honesty, sincerity, kindness, goodness, loyalty, patience, understanding…integrity.
20 to 49 employees
http://provider-resources.com/