Medicare QA & Compliance Manager (Remote)

WPS—A health solutions company; Town of Texas (WI); 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 full match for 3% and 50%

Health/dental/telehealth starting day

Professional and LeadershipDevelopment

Job summary

WPS Health Solutions is seeking a qualified QA Manager to oversee Quality Assurance activities for the Audit and Reimbursement department. You will serve as a subject matter expert in Medicare reimbursement and CMS regulations, driving continuous improvement and risk assessment across the program.

The role requires deep knowledge of PS&R, regulatory interpretation, and strong analytical and leadership skills.

Qualifications

• Bachelor’s degree or equivalent with 5+ years Medicare auditing/reimbursement experience.
• Extensive knowledge of auditing practices, Government Auditing Standards, and Medicare rules/regulations.
• Strong research skills and ability to interpret CMS regulations and Medicare reimbursement principles.
• Proven analytical, decision-making, and risk assessment abilities.
• Experience leading or participating in cross-functional teams and process improvement.

Responsibilities

• Coordinate QA activities for Medicare Audit and Reimbursement and monitor ongoing quality.
• Act as SME in Medicare reimbursement, CMS regulations, and cost reporting.
• Lead or participate in work groups and cross-functional initiatives to improve work papers, auditing techniques, and documentation.
• Respond to provider inquiries and external/internal stakeholders in a timely manner.
• Develop rebuttals and respond to audit findings; conduct IQC reviews and oversee quarterly meetings.

Skills

Auditing techniques

Regulatory interpretation

Analytical thinking

Risk assessment

Project management

Data analysis

Written & verbal communication

Education

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

Equivalent post high school education/work experience

Tools

PS&R

Job description

WPS Health Solutions is seeking a qualified QA Manager to oversee Quality Assurance activities for the Audit and Reimbursement department. You will serve as a subject matter expert in Medicare reimbursement and CMS regulations, driving continuous improvement and risk assessment across the program.

The role requires deep knowledge of PS&R, regulatory interpretation, and strong analytical and leadership skills.