Regulatory Process Manager (IDRE) in Erie, Pennsylvania at PROVIDER RESOURCES INC

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.