Medicare QA Lead — Remote, Reimbursement Expert

WPS—A health solutions company; South Carolina; À distance; USD 85 000 - 115 000; Plein temps

Avantages offerts par ce poste

Remote work options available

Performance bonus opportunities

401(k) with generous match

Résumé du poste

WPS, a health solutions company, is seeking a Quality Assurance Manager to coordinate QA activities across the Audit and Reimbursement department. You will serve as a CMS/regulations SME, leading technical guidance and quality monitoring to ensure compliant Medicare reimbursement practices.

You will drive process improvements, support IQC reviews, and respond to provider inquiries while collaborating with cross-functional teams to uphold Medicare program integrity.

Qualifications

• Bachelor’s degree in Accounting, Finance, Business Administration, or related field, or equivalent post high school education and/or work-related experience.
• 5+ years of progressive Medicare auditing and/or reimbursement experience.
• Extensive knowledge of auditing techniques, Government Auditing Standards, and Medicare rules/regulations.
• Strong understanding of PS&R and claims processing/pricing.
• Excellent researching skills and ability to locate authoritative sources.
• Experience in group facilitation, project management, data analysis, and risk assessment.

Responsabilités

• 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 periodic reviews and support QA process improvements.
• Ensure adherence to CMS regulations and Medicare rules.
• Lead or participate in cross-functional groups and regulatory initiatives.
• Respond to audits and inquiries from providers and internal/external customers.

Connaissances

Research skills

Analytical thinking

Decision making

Communication

Risk assessment

Project management

Formation

Bachelor's degree in Accounting/Finance/Business

Equivalent post high school education/work experience

Description du poste

WPS, a health solutions company, is seeking a Quality Assurance Manager to coordinate QA activities across the Audit and Reimbursement department. You will serve as a CMS/regulations SME, leading technical guidance and quality monitoring to ensure compliant Medicare reimbursement practices.

You will drive process improvements, support IQC reviews, and respond to provider inquiries while collaborating with cross-functional teams to uphold Medicare program integrity.