Medicare QA & Reimbursement Lead (Remote)

WPS—A health solutions company; Iowa; A distancia; USD 85.000 - 115.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Remote work options

Performance bonus

401(k) match

Paid time off

Health insurance

Dental insurance

Telehealth services

Leadership development

Descripción de la vacante

WPS, a health solutions company, seeks a Quality Assurance Manager to oversee QA activities for the Audit and Reimbursement department, with subject matter expertise in Medicare reimbursement and cost reporting. The role focuses on CMS adherence, risk assessment, and ongoing process improvements to safeguard Medicare funds.

The position requires strong analytical, research, and leadership skills, with experience in internal QA, regulatory interpretation, and cross-functional collaboration within

Formación

• Bachelor's degree or equivalent post high school education and/or work-related experience.
• 5+ years of Medicare auditing and/or reimbursement experience.
• Thorough knowledge of auditing techniques, Government Auditing Standards, and Medicare rules.
• Strong understanding of PS&R, claims processing, and pricing.

Responsabilidades

• Coordinate development, implementation, and monitoring of QA activities for Medicare Audit and Reimbursement.
• Lead interpretation of CMS regulations and Medicare reimbursement principles in complex scenarios.
• Respond to audit inquiries and provide timely research and rebuttals.
• Facilitate quarterly meetings and coordinate IQC reviews and reports.

Conocimientos

Medicare auditing

Reimbursement knowledge

CMS regulations

PS&R knowledge

Analytical skills

Risk assessment

Group facilitation

Project management

Communication skills

Educación

Bachelor's in Accounting/Finance/BA

Equivalent experience

Descripción del empleo

WPS, a health solutions company, seeks a Quality Assurance Manager to oversee QA activities for the Audit and Reimbursement department, with subject matter expertise in Medicare reimbursement and cost reporting. The role focuses on CMS adherence, risk assessment, and ongoing process improvements to safeguard Medicare funds.

The position requires strong analytical, research, and leadership skills, with experience in internal QA, regulatory interpretation, and cross-functional collaboration within