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

PRI LLC is an equal opportunity employer. We evaluate candidates on demonstrated skills and capability.