Medicare QA Lead: Remote Auditing & Compliance

WPS Health Solutions; Omaha (NE); Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Remote options

Bonus opportunities

401(k) match

Job summary

WPS Health Solutions is seeking a Quality Assurance Manager to coordinate and oversee QA activities within the Audit and Reimbursement department. You will act as a subject matter expert in Medicare reimbursement and cost reporting, providing technical leadership and monitoring QA processes for continuous improvement.

The role requires significant experience with Medicare rules, PS&R, CMS regulations, and risk assessment, with a strong emphasis on documentation, audits, and cross-functional

Qualifications

• Bachelor’s degree in Accounting, Finance, Business Administration, or related field or equivalent experience.
• 5+ years of progressive Medicare auditing and/or reimbursement experience.
• Extensive knowledge of auditing techniques, Government Auditing Standards, Medicare rules and regulations.
• Strong understanding of claims processing and PS&R.
• Excellent researching and analytical abilities.
• Proven ability to lead, manage projects and assess risk.

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 via periodic reviews and ongoing QA process improvements.
• Ensure adherence to CMS regulations and guidance.
• Lead or participate in cross-functional teams to improve work papers, auditing techniques, and documentation.

Education

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

Job description

WPS Health Solutions is seeking a Quality Assurance Manager to coordinate and oversee QA activities within the Audit and Reimbursement department. You will act as a subject matter expert in Medicare reimbursement and cost reporting, providing technical leadership and monitoring QA processes for continuous improvement.

The role requires significant experience with Medicare rules, PS&R, CMS regulations, and risk assessment, with a strong emphasis on documentation, audits, and cross-functional