Role Overview
This position supports MedRisk's Payment Integrity compliance program, acting as a regulatory subject-matter expert for workers' compensation, managed care, and medical billing operations. The role involves monitoring legislative and regulatory changes, managing state filings, and serving as the primary liaison with regulatory agencies, customers, and internal teams. The role manages a comprehensive team responsible for platform compliance.
Key Responsibilities
Regulatory & Compliance
Monitor and analyze state/federal regulatory developments, legislation, and industry trends affecting workers' compensation.
Research, track, and assess regulatory impacts on managed care, bill review, and timely pay operations.
Communicate regulatory changes to internal teams and customers.
Develop compliance training materials with subject-matter expertise.
Support URAC certification and reaccreditation for clinical operations.
Managed Care & Filing
Manage certified managed care programs (MPN/MCO) including state filings, renewals, amendments, and reporting.
Manage state regulatory agencies on filings, audits, deficiencies, and inquiries.
Maintain historical archives and resource documentation for state filings.
Team & Operations
Coordinate resources to ensure ongoing effectiveness of state managed care programs.
Support cross-functional projects and compliance documentation.
Requirements
Education: Bachelor's degree in business administration or related field.
Experience: 10+ years in business or industry, with significant experience in workers' compensation state managed care and medical bill review.
Skills: Regulatory research and interpretation, project management in regulated environments, communication (oral/written), attention to detail, problem-solving, and self-starter mindset
