Director-Regulatory Compliance

MedRisk•Conshohocken, PA

1d•$140,000 - $160,000

About The Position

This position supports MedRisk's Payment Integrity compliance program and serves as a regulatory subject-matter expert for workers’ compensation, managed care, and medical billing operations. The role monitors legislative and regulatory changes, manages state filings, and serves as a primary liaison with regulatory agencies, customers, and internal teams. It also manages a comprehensive team responsible for platform compliance.

Requirements

Bachelor’s degree in business administration or a related field.
At least 10 years of experience in business or industry, with significant experience in workers’ compensation state managed care and medical bill review.
Regulatory research and interpretation skills.
Project management experience in regulated environments.
Strong oral and written communication skills.
Attention to detail.
Problem-solving skills.
Self-starter mindset.

Responsibilities

Monitor and analyze state and 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 using subject-matter expertise.
Support URAC certification and reaccreditation for clinical operations.
Manage certified managed care programs (MPN/MCO), including state filings, renewals, amendments, and reporting.
Manage interactions with state regulatory agencies regarding filings, audits, deficiencies, and inquiries.
Maintain historical archives and resource documentation for state filings.
Coordinate resources to ensure the ongoing effectiveness of state managed care programs.
Support cross-functional projects and compliance documentation.