Medicare QA & Reimbursement Lead

WPS—A health solutions company; Indiana; Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Remote work options

Bonus opportunities

401(k) match

Paid time off

Health insurance

Dental insurance

Telehealth services

Leadership development

Job summary

WPS Health Solutions is seeking a Quality Assurance Manager to oversee QA activities for the Audit and Reimbursement department. You will serve as a subject matter expert in Medicare reimbursement and cost reporting, ensuring CMS regulations are followed while guiding risk assessment and continuous improvement initiatives.

The role supports remote work in approved states and emphasizes cross-functional collaboration to strengthen stewardship of Medicare funds.

Qualifications

• Bachelor's degree in Accounting, Finance, Business or related field.
• 5+ years in Medicare auditing or reimbursement.
• Deep knowledge of auditing standards, Government Auditing Standards and Medicare rules.
• Understanding of PS&R data, pricing, and claims processing.
• Strong research and analytical abilities.
• Ability to lead groups, manage projects, and assess risk.
• Excellent written and verbal communication skills.

Responsibilities

• Lead development and monitoring of QA processes within Medicare Audit and Reimbursement.
• Provide SME guidance on Medicare reimbursement and cost reporting.
• Ensure CMS rule adherence and manage risk assessments.
• Coordinate cross-functional projects to improve work papers and documentation.
• Respond to audits and stakeholder inquiries with clear, researched responses.

Skills

Medicare auditing

Cost reporting

Risk assessment

Data analysis

Project management

Regulatory interpretation

CMS regulations

IQC reviews

Education

Bachelor's degree in Accounting/Finance/Business

Tools

PS&R

Job description

WPS Health Solutions is seeking a Quality Assurance Manager to oversee QA activities for the Audit and Reimbursement department. You will serve as a subject matter expert in Medicare reimbursement and cost reporting, ensuring CMS regulations are followed while guiding risk assessment and continuous improvement initiatives.

The role supports remote work in approved states and emphasizes cross-functional collaboration to strengthen stewardship of Medicare funds.