Regulatory Process Manager (IDRE)

Job description

About PRI LLC:
Provider Resources Inc. (PRI LLC) is a federally certified Independent Dispute Resolution Entity (IDRE) and Independent Review Organization (IRO) operating under the No Surprises Act. We process payment disputes that directly protect patients from unexpected medical bills - and we do it at scale, with precision, in one of the most scrutinized regulatory environments in healthcare. We are a growth-stage company of approximately 200 people, backed by a search fund, and building the systems and team that will define PRI LLC for the next decade.

The Role:
We are looking for a Regulatory Process Manager - PRI LLC's subject matter expert and go-to investigator for complex issues within the No Surprises Act IDR process. This is a senior individual contributor role that sits at the intersection of regulatory expertise, case investigation, and process improvement.

You will be the person PRI LLC calls on when a dispute is complex, a CMS guidance question is novel, or an exception pattern needs someone to dig in and figure out what is happening. You will investigate, document, recommend, and communicate - and you will do it independently, at speed, without needing a committee to validate your work.

What You Will Do:
*Interpret NSA rules, CMS guidance, and PRI LLC procedures in real time without escalating routine questions upward
*Investigate complex exceptions in our case files - identify root causes, report patterns, recommend process improvements
*Conduct audit-level case file reviews in GlideOps to answer stakeholder questions with specificity and documentation
*Track CMS guidance and interim final rules; communicate relevant changes to internal stakeholders proactively
*Manage escalated disputes through to resolution, coordinating with QA, compliance, and operations
*Support the CCO and VP Compliance on CMS and URAC audits and regulatory correspondence
*Collaborate with L&D and Compliance on developing training content for complex IDR process areas
*Represent PRI LLC at external meetings, webinars, and educational events as a subject matter authority

What We Are Looking For:
*JD or LLM preferred; significant NSA/IDRE operational, regulatory, or arbitration experience considered in lieu
*Arbitration experience - IDR arbitration ideal; AAA, JAMS, AHLA, or commercial arbitration background considered
*Deep familiarity with the No Surprises Act IDR process - you know it well enough to catch errors and explain edge cases
*Auditor instinct: when something is complex, you move toward it, not away from it
*Experience identifying patterns across large case volumes and translating them into process improvements
*Ability to make decisions independently and move fast without committee input on regulatory questions
*Prior IDRE, IRO, managed care, utilization review, or healthcare regulatory environment experience

Why PRI LLC:
*Meaningful work - PRI LLC processes disputes that directly protect patients from unexpected medical bills under federal law
*Growth stage - we are building the systems, processes, and team that will define PRI LLC for the next decade
*Skills framework - every role at PRI LLC has a defined skills ontology with clear growth paths and Udemy Business development pathways
*High-visibility role - your work shapes how PRI LLC operates at the regulatory edge; findings you surface reach executive leadership
*Direct leadership access - small enough that your work is visible; structured enough that decisions get made

As an EEO/Affirmative Action Employer all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status.

Benefits and Compensation Provider Resources provides a competitive benefits package that includes access to Medical, Dental, and Vision Insurance, Life Insurance, Disability, Health Savings Account (HSA), Flexible Spending Accounts (FSA), Critical Illness, Accident, Legal and ID Theft, 401k plan, PTO. The anticipated salary range for fully qualified candidates applying for this role will be above (not including discretionary bonus, equity, and benefits). The final salary offered will be dependent on several factors that include but are not limited to relevant previous experience including duration and type of experience within the industry, education, and internal equity.