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Compliance Auditing Manager
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Ascend Metal Fabricators
Erie, PA (In Person)
Full-Time
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Job Description
Compliance Auditing Manager
Erie, PA
2 DAYS AGO
22645806
Summary
Erie, PA
In-Person
Competitive Salary
5 Years Experience
High school graduate or equivalency certificate (GED)
No Commission
40.00 hours per week / Day Shift / Full-Time
Description 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:
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 preparationWhat 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 matterPRI is an equal opportunity employer.