Medicare QA Lead: Reimbursement & Compliance (Remote)

WPS Health Solutions; Minneapolis (MN); Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Remote work options

Performance bonus or merit increases

100% match 401(k) up to 3% + 50% up to

Competitive paid time off

Health, dental, telehealth starting on

Professional and LeadershipDevelopment

Job summary

WPS Health Solutions is seeking a Quality Assurance Manager to coordinate QA activities for the Audit and Reimbursement department. You will be the Medicare reimbursement SME, provide technical leadership, and monitor quality through reviews while driving continuous QA process improvements.

The role emphasizes risk assessment, interpretation of CMS regulations, and collaborative work across cross-functional teams to enhance documentation standards and compliance.

Qualifications

• Bachelor's degree in Accounting, Finance, Business Administration, or related field.
• 5 or more years of progressive experience in Medicare auditing and/or Reimbursement activity.
• Extensive, thorough knowledge of auditing techniques, Government Auditing Standards and Medicare rules and regulations.
• Thorough knowledge and understanding of claims processing and pricing and the Provider Statistical and Reimbursement Report (PS&R).
• Excellent researching skills and understanding of the types and hierarchy of authoritative sources.
• Demonstrated expertise in complex reimbursement methodologies and cost allocation principles.
• Proven analytical, decision making and judgment abilities.
• Demonstrated skill in group facilitation, project management, data analysis, and risk assessment.
• Strong skills with professional, technical written and verbal communications.

Responsibilities

• Coordinate and oversee the development, implementation, and monitoring of QA activities for the Audit and Reimbursement department.
• Serve as subject matter expert in Medicare reimbursement and cost reporting; provide technical leadership.
• Monitor quality through periodic reviews and drive continuous improvement of QA processes.
• Interpret CMS regulations, Medicare reimbursement principles, and Government Auditing Standards for complex scenarios.
• Lead or participate in cross-functional work groups and regulatory implementation initiatives to improve work papers, auditing techniques, and documentation standards.

Job description

WPS Health Solutions is seeking a Quality Assurance Manager to coordinate QA activities for the Audit and Reimbursement department. You will be the Medicare reimbursement SME, provide technical leadership, and monitor quality through reviews while driving continuous QA process improvements.

The role emphasizes risk assessment, interpretation of CMS regulations, and collaborative work across cross-functional teams to enhance documentation standards and compliance.