Director-Regulatory Compliance

MedRisk LLC; West Conshohocken (PA); On-site; USD 140,000 - 160,000; Full time

Job summary

MedRisk LLC in Conshohocken, PA seeks a Director-Regulatory Compliance to lead its regulatory program across workers’ compensation, managed care, and medical billing operations. You will monitor legislative changes, manage state filings, and serve as the main liaison with regulatory agencies, customers, and internal teams.

The role also oversees a team responsible for platform compliance, develops training materials, supports URAC certification, and coordinates cross‑functional projects to

Qualifications

• Bachelor's degree or equivalent in business administration or related field.
• At least 10+ years in business or industry with workers’ compensation state managed care and medical bill review.
• Strong regulatory research, interpretation, project management and communication skills.

Responsibilities

• Monitor and analyze state and federal regulatory developments impacting workers’ compensation and managed care.
• Research, track, and assess regulatory impacts on bill review and timely pay operations.
• Communicate regulatory changes to internal teams and customers.
• Develop compliance training materials for regulatory excellence.
• Support URAC certification and reaccreditation for clinical operations.
• Manage state filings, renewals, amendments and reporting for certified managed care programs.
• Coordinate resources and cross‑functional projects to ensure ongoing program effectiveness.

Skills

Regulatory research

Regulatory interpretation

Project management

Communication

Attention to detail

Problem solving

Self-starter mindset

Education

Bachelor's degree in business administration or related field

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Director-Regulatory Compliance

IT Product Planning Management Conshohocken, PA, US

Salary Range: $140,000.00 To $160,000.00 Annually

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