Compliance Auditing Manager

Job description

About the role:
Provider Resources Inc. (PRI) is looking for a Manager of Compliance Auditing 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.