Director of Operations (IDRE)

Job description

Provider Resources Inc. (PRI) is a growing Independent Dispute Resolution Entity (IDRE) operating under the No Surprises Act. We process payment disputes between health plans and providers - work that directly protects patients from unexpected medical bills. We are headquartered in the US with approximately 200 employees and are expanding rapidly.

ABOUT THE ROLE
We are hiring a Director of IDRE Operations to run our payment determination function day to day. This role reports to our VP of IDRE Operations and manages four experienced Operations Managers across payment determination pods, eligibility, and business support. If you have deep IDRE or healthcare dispute resolution operations experience, have managed managers, and are driven by data - this role was built for you.

WHAT YOU WILL DO
*Own throughput, SLA performance, and operational quality across all payment determination pods
*Manage, develop, and hold accountable four Operations Managers
*Build and maintain operational data and reporting - from daily metrics to audit-period evidence
*Standardize processes across pods - identify inconsistency, build SOPs, measure adherence
*Lead CMS audit readiness for the operations layer - evidence standards, documentation, mock audits, staff preparation
*Partner with HR on capacity planning and with QA and compliance on cross-functional feedback loops

WHAT WE ARE LOOKING FOR
*7+ years in IDRE or healthcare dispute resolution operations - payment determination expertise at the case level is required
*Experience managing Operations Managers, not just individual contributors - this is a manager-of-managers role
*Data-driven - you build and use leading indicators, not just lag metrics
*Has prepared for and executed through a CMS or equivalent federal audit from the operations side
*Process improvement orientation with measurable results across multiple teams

WHY PRI
*Meaningful work - IDR dispute resolution under the No Surprises Act has real impact on patients and providers
*Growth stage - we are building the people, process, and data capability that will define PRI for the next decade
*Clear development path - PRI uses a skills ontology framework with defined growth levels and Udemy pathways for every role
*Lean and fast - decisions get made, things get built, and your work is visible

PRI is an equal opportunity employer. We evaluate candidates on demonstrated skills and capability, not credentials alone.