Medicare QA & Compliance Leader (Remote)

WPS Health Solutions; Newark (NJ); Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Remote work options available

Performance bonus

401(k) with match

Health insurance

Professional development

Day 1 benefits

Job summary

WPS Health Solutions seeks a Quality Assurance Manager to coordinate QA activities for the Audit and Reimbursement department and serve as a subject matter expert in Medicare reimbursement and cost reporting.

They will lead risk assessment, interpret CMS rules, monitor quality, and drive continuous improvement to safeguard Medicare funds. Remote options are available for qualified states, including New Jersey.

Qualifications

• Bachelor's degree or equivalent in a related field.
• 5+ years of Medicare auditing or reimbursement experience.
• Strong knowledge of auditing techniques and Government Auditing Standards.

Responsibilities

• Coordinate development and monitoring of QA activities for Audit and Reimbursement.
• Lead IQC reviews and issue IQC reports to Medicare teams.
• Interpret CMS regulations and Medicare reimbursement principles.
• Conduct quarterly meetings with management and field staff on IQC findings.
• Review forms for accuracy, testing, and regulatory compliance.

Skills

Medicare reimbursement

Quality assurance

Regulatory interpretation

Project management

Data analysis

Education

Bachelor's degree in Accounting/Finance/Business Administration

Tools

PS&R

Job description

WPS Health Solutions seeks a Quality Assurance Manager to coordinate QA activities for the Audit and Reimbursement department and serve as a subject matter expert in Medicare reimbursement and cost reporting.

They will lead risk assessment, interpret CMS rules, monitor quality, and drive continuous improvement to safeguard Medicare funds. Remote options are available for qualified states, including New Jersey.