Manager of Compliance Audit

About The Role

Provider Resources Inc. (PRI) is seeking a Manager of Compliance Audit to oversee their IDR determination audit function. This role is designed for a compliance professional with extensive experience in IDR and No Surprises Act knowledge, capable of auditing case-level determinations, identifying systemic patterns, and driving corrective actions in a rapidly growing, CMS-regulated setting.

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
• Lane 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.