Medicare QA & Compliance Lead (Remote)

WPS Health Solutions; Indianapolis (IN); Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Remote work options

Performance bonus

401(k) match

Health and dental insurance

Paid time off

Job summary

WPS Health Solutions seeks a Quality Assurance Manager to coordinate and oversee QA activities for the Audit and Reimbursement department. You will serve as a Medicare reimbursement and cost reporting SME, provide technical leadership, monitor quality, and drive CMS compliance initiatives.

This role supports risk assessment and continuous improvement in Medicare funds stewardship. The position offers remote work options across approved states, competitive salary in the 85k–115k range, and

Qualifications

• Bachelor's degree or equivalent education.
• 5+ years of Medicare auditing and/or Reimbursement experience.
• Extensive, thorough knowledge of auditing techniques, practices and issues, Government Auditing Standards and Medicare rules and regulations.
• Thorough knowledge and understanding of claims processing and pricing and the Provider Statistical and Reimbursement Report (PS&R).
• Excellent researching skills and understanding of the types and hierarchy of authoritative sources.
• Demonstrated expertise in complex reimbursement methodologies and cost allocation principles.
• Proven analytical, decision making and judgment abilities.
• Demonstrated skill in group facilitation, project management, data analysis, and risk assessment.
• Strong skills with professional, technical written and verbal communications.

Responsibilities

• Facilitate development and implementation of Quality Assurance activities and monitoring within Medicare Audit and Reimbursement.
• Respond to audit staff on various audit research issues and review NAH provider programs.
• Lead quarterly meetings with Medicare Audit and Reimbursement Management and Field Audit Supervisors.
• Complete quarterly Reopening and Appeals Reviews ensuring compliance with Medicare regulations.
• Review and approve forms to ensure accuracy and testing integrity.
• Interpret and apply CMS regulations and Medicare reimbursement principles in complex scenarios.
• Lead or participate in work groups and cross-functional projects to improve guidelines and documentation.

Skills

Auditing techniques

Medicare rules

PS&R knowledge

Research skills

Group facilitation

Data analysis

Risk assessment

Communications

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 coordinate and oversee QA activities for the Audit and Reimbursement department. You will serve as a Medicare reimbursement and cost reporting SME, provide technical leadership, monitor quality, and drive CMS compliance initiatives.

This role supports risk assessment and continuous improvement in Medicare funds stewardship. The position offers remote work options across approved states, competitive salary in the 85k–115k range, and