Medicare QA & Compliance Manager - Remote

WPS—A health solutions company; Nebraska; Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Remote work options available

Performance bonus and merit increases

401(k) with employer match

Job summary

WPS, a health solutions company, seeks a Quality Assurance Manager to coordinate QA for the Audit and Reimbursement department, specializing in Medicare reimbursement and cost reporting. You will serve as a subject matter expert, provide technical leadership, and drive improvement of QA processes.

This role ensures CMS compliance, conducts risk assessments, interprets regulations, and supports ongoing development of QA methodologies to safeguard Medicare funds, with remote work options across

Qualifications

• Bachelor’s degree or equivalent in accounting, finance, business administration or related field.
• 5+ years of progressive Medicare auditing and/or reimbursement experience.
• Extensive knowledge of auditing techniques and Government Auditing Standards.
• Thorough understanding of claims processing and PS&R.
• Strong research, analytical, and communication skills.

Responsibilities

• Coordinate and oversee QA activities for the Audit and Reimbursement department.
• Interpret CMS regulations and Medicare reimbursement principles in complex scenarios.
• Lead or participate in cross-functional groups to improve work paper guidance and auditing techniques.
• Conduct IQC reviews and support quarterly reviews with management and staff.

Skills

Medicare auditing

Reimbursement knowledge

Government Auditing Standards

Analytical skills

Data analysis

Regulatory interpretation

Risk assessment

Communication skills

Education

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

Tools

PS&R knowledge

Medicare rule references

Job description

WPS, a health solutions company, seeks a Quality Assurance Manager to coordinate QA for the Audit and Reimbursement department, specializing in Medicare reimbursement and cost reporting. You will serve as a subject matter expert, provide technical leadership, and drive improvement of QA processes.

This role ensures CMS compliance, conducts risk assessments, interprets regulations, and supports ongoing development of QA methodologies to safeguard Medicare funds, with remote work options across