Medicare QA & Compliance Lead (Remote)

WPS Health Solutions; Charlotte (NC); Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Remote work options

Performance bonus

401(k) with full match up to 3%, 50% 4

Health/dental/telehealth starting Day

Job summary

WPS Health Solutions is seeking a Quality Assurance Manager to coordinate QA activities for the Audit and Reimbursement department. You will act as a subject matter expert in Medicare reimbursement and cost reporting, providing technical leadership and monitoring quality through reviews.

The role focuses on interpreting CMS regulations, leading QA process improvements, and ensuring compliance in Medicare-related contracts.

Qualifications

• Bachelor's degree in Accounting, Finance, Business Administration, or related field, or equivalent post high school education and/or work-related experience.
• 5+ years of progressive experience in Medicare auditing and/or Reimbursement activity.
• Extensive knowledge of auditing techniques, Government Auditing Standards, and Medicare rules.
• Thorough knowledge and understanding of PS&R (Provider Statistical and Reimbursement).
• Strong analytical and written/verbal communication skills.

Responsibilities

• Coordinate and oversee QA activities for Audit and Reimbursement.
• Serve as SME in Medicare reimbursement and cost reporting.
• Monitor quality through periodic reviews and ongoing QA development.
• Lead cross-functional groups to improve work paper guidelines and documentation standards.

Skills

Quality Assurance

Medicare knowledge

Regulatory interpretation

Risk assessment

Communication

Education

Bachelor's degree in related field

Job description

WPS Health Solutions is seeking a Quality Assurance Manager to coordinate QA activities for the Audit and Reimbursement department. You will act as a subject matter expert in Medicare reimbursement and cost reporting, providing technical leadership and monitoring quality through reviews.

The role focuses on interpreting CMS regulations, leading QA process improvements, and ensuring compliance in Medicare-related contracts.