Medicare QA & Compliance Leader (Remote)

WPS Health Solutions; Denver (CO); Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Remote work options available

401(k) with match

Health insurance

Paid time off

Job summary

WPS Health Solutions is seeking a Quality Assurance Manager to oversee QA activities for the Audit and Reimbursement department. The role focuses on Medicare reimbursement, cost reporting, and CMS compliance, driving continuous improvement and risk assessment across programs.

As the subject matter expert, you will provide technical leadership, monitor quality through reviews, and coordinate development and implementation of QA processes that ensure regulatory adherence and efficient operation.

Qualifications

• Bachelor-level degree or equivalent experience and knowledge of auditing techniques.
• Extensive knowledge of auditing practices, Government Auditing Standards, and Medicare rules.
• Understanding of PS&R and claims processing.
• Strong research abilities and knowledge of authoritative sources.

Responsibilities

• Coordinate and oversee QA activities for the Audit and Reimbursement department.
• Provide Medicare reimbursement and cost reporting subject matter expertise.
• Lead QA process development, implementation, and monitoring.
• Conduct IQC reviews and issue IQC reports to management.
• Facilitate quarterly meetings with audit staff and field supervisors.
• Interpret CMS regulations and apply Medicare reimbursement principles.
• Lead cross-functional work groups for documentation and auditing standards.

Skills

Medicare auditing and reimbursement

Government Auditing Standards

CMS regulations

Analytical skills

Project management

Communication skills

Risk assessment

Education

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

Job description

WPS Health Solutions is seeking a Quality Assurance Manager to oversee QA activities for the Audit and Reimbursement department. The role focuses on Medicare reimbursement, cost reporting, and CMS compliance, driving continuous improvement and risk assessment across programs.

As the subject matter expert, you will provide technical leadership, monitor quality through reviews, and coordinate development and implementation of QA processes that ensure regulatory adherence and efficient operation.