Medicare QA & Reimbursement Manager

WPS Health Solutions; Monona (WI); Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Remote work options available

Performance bonus opportunities

401(k) with company match

Job summary

WPS Health Solutions is seeking a Quality Assurance Manager to coordinate QA activities in the Audit and Reimbursement department. The role requires SME status in Medicare reimbursement, with responsibility for implementing and monitoring QA processes in line with CMS regulations.

You will lead risk assessments, provide technical guidance, and drive continuous improvement of QA practices, including quarterly reviews and regulatory adherence across MAC contracts and related audits.

Qualifications

• Bachelor's degree in related field or equivalent work experience.
• 5+ 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 PS&R and reimbursement concepts.
• Strong researching skills and understanding of authoritative sources.

Responsibilities

• Coordinate and oversee the development, implementation, and monitoring of QA activities for the Audit and Reimbursement department.
• Serve as SME in Medicare reimbursement and cost reporting; provide technical leadership.
• Ensure adherence to CMS regulations and drive continuous improvement of QA processes.
• Lead or participate in cross-functional work groups and regulatory initiatives.
• Conduct IQC reviews and prepare IQC reports; present findings to management.

Skills

Medicare auditing

Reimbursement

Regulatory compliance

Risk assessment

Analytical abilities

Project management

Data analysis

Communication skills

Education

Bachelor's degree in Accounting, Finance, Business Administration

Tools

PS&R

Job description

WPS Health Solutions is seeking a Quality Assurance Manager to coordinate QA activities in the Audit and Reimbursement department. The role requires SME status in Medicare reimbursement, with responsibility for implementing and monitoring QA processes in line with CMS regulations.

You will lead risk assessments, provide technical guidance, and drive continuous improvement of QA practices, including quarterly reviews and regulatory adherence across MAC contracts and related audits.