Medicare QA & Compliance Manager (Remote)

WPS Health Solutions; Kansas City (MO); 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 the first 3

401(k) match for next 2% of salary

Health insurance

Dental insurance

Telehealth services

Paid time off

Professional and LeadershipDevelopment

Job summary

WPS Health Solutions seeks a Quality Assurance Manager to lead QA activities for the Audit and Reimbursement department, serving as a subject matter expert in Medicare reimbursement and cost reporting. You will oversee QA program development, monitor compliance with CMS regulations, and drive continuous improvement across the QA process.

The role emphasizes risk assessment, regulatory interpretation, and collaboration with management to ensure accuracy and efficiency in Medicare-related audits

Qualifications

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

Responsibilities

• Coordinate and oversee QA activities for the Audit and Reimbursement department.
• Serve as SME in Medicare reimbursement and cost reporting; provide technical leadership.
• Monitor quality through reviews and continuous improvement of QA processes.
• Conduct IQC reviews and issue reports to Medicare Audit and Reimbursement Management.
• Lead quarterly meetings to discuss IQC findings and regulatory implementation.
• Review forms for accuracy and testing; respond to inquiries from internal/external customers.
• Interpret CMS regulations and Medicare reimbursement concepts for complex scenarios.

Skills

Quality Assurance

Medicare reimbursement

Regulatory interpretation

Risk assessment

Data analysis

Project management

Leadership

Written and verbal communication

Education

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

Tools

PS&R knowledge

Auditing software (general)

Job description

WPS Health Solutions seeks a Quality Assurance Manager to lead QA activities for the Audit and Reimbursement department, serving as a subject matter expert in Medicare reimbursement and cost reporting. You will oversee QA program development, monitor compliance with CMS regulations, and drive continuous improvement across the QA process.

The role emphasizes risk assessment, regulatory interpretation, and collaboration with management to ensure accuracy and efficiency in Medicare-related audits