Medicare QA & Reimbursement Lead (Remote)

WPS—A health solutions company; Indianapolis (IN); Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Remote work options

Performance bonus

401(k) match

Health insurance

Dental insurance

Telehealth

Job summary

WPS, a health solutions company, is seeking a Quality Assurance Manager to oversee Medicare Audit and Reimbursement QA activities and ensure CMS compliance. You will lead QA initiatives, interpret Medicare rules, and drive continuous improvement across the program.

The role requires strong auditing expertise, risk assessment, and collaboration with management and field staff to respond to inquiries and support contract obligations.

Qualifications

• Bachelor's degree or equivalent experience in a relevant field.
• 5+ years of Medicare auditing/reimbursement experience.
• Extensive knowledge of auditing techniques and Government Auditing Standards.
• Thorough understanding of claims processing and PS&R.
• Strong research skills and understanding of authoritative sources.
• Experience with complex reimbursement methodologies and cost allocation.

Responsibilities

• Lead and oversee Quality Assurance activities for Medicare Audit and Reimbursement.
• Provide expert interpretation of CMS regulations and Medicare reimbursement principles.
• Monitor QA quality through periodic reviews and risk assessments.
• Develop and implement QA processes and guidelines; drive continuous improvement.
• Respond to audit staff inquiries and support MAC contract reviews (J5/J8).
• Coordinate quarterly meetings to discuss IQC findings and ensure compliance.

Skills

Medicare auditing

Reimbursement knowledge

Government Auditing Standards

Regulatory interpretation

Risk assessment

Data analysis

Leadership

Project management

Communication

Education

Bachelor's degree in Accounting/Finance/Business Administration or related field

Tools

PS&R

CMS regulations

Job description

WPS, a health solutions company, is seeking a Quality Assurance Manager to oversee Medicare Audit and Reimbursement QA activities and ensure CMS compliance. You will lead QA initiatives, interpret Medicare rules, and drive continuous improvement across the program.

The role requires strong auditing expertise, risk assessment, and collaboration with management and field staff to respond to inquiries and support contract obligations.