Medicare QA Leader — Remote Compliance & Risk

WPS Health Solutions; Hampton (VA); Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Remote work options

Performance bonus

401(k) with employer match

Paid time off

Health, dental, telehealth from Day 1

Professional and Leadership Dev

Job summary

WPS Health Solutions is seeking a Quality Assurance Manager to oversee QA activities for the Audit and Reimbursement department. The role acts as a SME in Medicare reimbursement and cost reporting, providing technical leadership and guiding QA process improvements in alignment with CMS regulations.

The position offers remote work eligibility across approved states, a salary range of $85,000 to $115,000, and opportunities for professional development and performance-based bonuses.

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 knowledge of auditing techniques, Government Auditing Standards, and Medicare rules and regulations.
• Thorough knowledge of claims processing, PS&R, and reimbursement methodologies.
• Excellent researching skills and ability to interpret authoritative sources.
• Demonstrated analytical, decision-making, and risk assessment abilities.
• Strong group facilitation, project management, and communication skills.

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 and monitor quality through periodic reviews.
• Ensure adherence to CMS regulations and drive continuous improvement of QA processes.
• Lead or participate in cross-functional work groups and regulatory initiatives.

Skills

Medicare auditing

PS&R knowledge

Cost reporting

Regulatory interpretation

Data analysis

Project management

Communication

Risk assessment

Education

Bachelor's degree in Accounting/Finance/Business Administration

Job description

WPS Health Solutions is seeking a Quality Assurance Manager to oversee QA activities for the Audit and Reimbursement department. The role acts as a SME in Medicare reimbursement and cost reporting, providing technical leadership and guiding QA process improvements in alignment with CMS regulations.

The position offers remote work eligibility across approved states, a salary range of $85,000 to $115,000, and opportunities for professional development and performance-based bonuses.