Medicare QA & Reimbursement Manager

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

Benefits offered by this job

Remote work options

Performance bonus and merit increases

401(k) with company match

Generous PTO

Health, dental, and telehealth

Professional development programs

Job summary

WPS, a health solutions company, seeks a Quality Assurance Manager to oversee QA for the Audit and Reimbursement group, serving as an expert in Medicare reimbursement and cost reporting. You will provide technical leadership, monitor quality, and drive ongoing QA process improvements under CMS guidelines.

The role emphasizes risk assessment, regulatory interpretation, and collaboration across teams to strengthen reimbursement accuracy and compliance, with remote work options in numerous states

Qualifications

• Bachelor's degree or equivalent education and/or work experience in accounting, finance, or related field.
• 5+ years of Medicare auditing or reimbursement experience.
• Strong knowledge of auditing standards and Medicare rules.
• Understanding of PS&R claims processing and pricing.
• Analytical mindset with strong written and verbal communication.

Responsibilities

• Coordinate QA activities for Audit and Reimbursement to ensure regulatory compliance.
• Lead reviews, respond to issues, and develop rebuttals for QA findings.
• Conduct IQC reviews and report to Medicare Audit and Reimbursement management.
• Facilitate quarterly IQC meetings with management and staff.

Skills

Medicare auditing

Reimbursement processes

Regulatory interpretation

Data analysis

Project management

Risk assessment

Communication

Education

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

Tools

PS&R

Job description

WPS, a health solutions company, seeks a Quality Assurance Manager to oversee QA for the Audit and Reimbursement group, serving as an expert in Medicare reimbursement and cost reporting. You will provide technical leadership, monitor quality, and drive ongoing QA process improvements under CMS guidelines.

The role emphasizes risk assessment, regulatory interpretation, and collaboration across teams to strengthen reimbursement accuracy and compliance, with remote work options in numerous states