Medicare QA & Compliance Lead (Remote)

WPS Health Solutions; Des Moines (IA); Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Remote work options

Performance bonus

401(k) match

Day 1 health insurance

Job summary

WPS Health Solutions is hiring a Quality Assurance Manager to coordinate QA activities for the Audit and Reimbursement department. You will serve as a subject matter expert in Medicare reimbursement and cost reporting, providing technical leadership and driving QA process improvements.

The role requires extensive knowledge of CMS regulations, risk assessment, and ongoing development of QA standards to ensure compliant, efficient Medicare-related practices.

Qualifications

• Bachelor’s degree in Accounting, Finance, Business Administration, or related field.
• 5+ years in Medicare auditing and/or Reimbursement.
• Extensive knowledge of auditing, Government Auditing Standards, and Medicare rules/regulations.
• Thorough knowledge of claims processing and PS&R.
• Strong analytical, decision-making, and risk assessment abilities.
• Excellent written and verbal communication skills.

Responsibilities

• Coordinate and oversee QA activities within Audit and Reimbursement.
• Serve as SME in Medicare reimbursement and cost reporting.
• Lead risk assessment and CMS regulation interpretation efforts.
• Drive continuous improvement of QA processes and documentation.

Skills

Quality Assurance

Medicare knowledge

Regulatory interpretation

Project management

Data analysis

Communication skills

Education

Bachelor's degree in related field

Tools

PS&R knowledge

Job description

WPS Health Solutions is hiring a Quality Assurance Manager to coordinate QA activities for the Audit and Reimbursement department. You will serve as a subject matter expert in Medicare reimbursement and cost reporting, providing technical leadership and driving QA process improvements.

The role requires extensive knowledge of CMS regulations, risk assessment, and ongoing development of QA standards to ensure compliant, efficient Medicare-related practices.