Medicare QA & Compliance Lead — Remote

WPS Health Solutions; Columbus (OH); Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Remote work options available

Performance bonus

401(k) with 100% match for first 3% +

50% match for next 2%

Job summary

WPS Health Solutions seeks a Quality Assurance Manager to oversee QA activities for the Audit and Reimbursement department, serving as a subject matter expert in Medicare reimbursement and cost reporting. You will lead risk assessment, CMS interpretation, and continuous improvement initiatives to steward Medicare funds.

The role emphasizes regulatory compliance, IQC reviews, and cross-functional collaboration with management and staff to enhance work papers, documentation standards, and audit

Qualifications

• Bachelor's degree or equivalent in a related field is required.
• 5+ years of Medicare auditing or reimbursement experience.
• Extensive knowledge of auditing techniques, Government Auditing Standards, and Medicare rules/regulations.
• Strong understanding of claims processing and PS&R.
• Excellent researching skills and knowledge of authoritative sources.
• Experience with complex reimbursement methodologies and cost allocation.
• Analytical, decisive, and judgment abilities.
• Proven facilitation, project management, data analysis, and risk assessment skills.
• Strong written and verbal communication abilities.

Responsibilities

• Lead development, implementation, and monitoring of QA activities for Medicare Audit and Reimbursement.
• Provide technical leadership and CMS regulation interpretation.
• Perform IQC reviews and issue IQC reports.
• Conduct quarterly meetings to discuss IQC findings with management and staff.
• Respond to audit staff inquiries and develop rebuttals for issues found in QASP reviews.
• Support continuous improvement of work papers and documentation standards.

Skills

Medicare auditing

Cost reporting

Government Auditing Standards

PS&R knowledge

Data analysis

Project management

Communication

Risk assessment

Education

Bachelor's degree in Accounting/Finance/Business Administration or related field

Equivalent post high school education or work-related experience

Job description

WPS Health Solutions seeks a Quality Assurance Manager to oversee QA activities for the Audit and Reimbursement department, serving as a subject matter expert in Medicare reimbursement and cost reporting. You will lead risk assessment, CMS interpretation, and continuous improvement initiatives to steward Medicare funds.

The role emphasizes regulatory compliance, IQC reviews, and cross-functional collaboration with management and staff to enhance work papers, documentation standards, and audit