Medicare QA & Reimbursement Manager (Remote)

WPS Health Solutions; Jacksonville (FL); Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Remote work options

Performance bonus

401(k) with company match

Paid time off

Health insurance

Dental insurance

Telehealth

Leadership development programs

Job summary

WPS Health Solutions is seeking a Quality Assurance Manager to coordinate and oversee QA activities within the Audit and Reimbursement department. This role acts as a subject matter expert in Medicare reimbursement and cost reporting, providing technical leadership and driving QA improvements.

You will monitor quality through reviews, interpret CMS regulations, and support risk assessment and continuous improvement initiatives that protect Medicare funds.

Qualifications

• Bachelor's degree in a relevant field or equivalent experience.
• 5+ years of progressive Medicare auditing or reimbursement experience.
• Extensive knowledge of auditing techniques, Government Auditing Standards and Medicare rules.
• Understanding of claims processing, pricing, and PS&R.
• Strong research and analytical abilities.
• Expertise in cost allocation principles and risk assessment.
• Proven facilitation, project management, and communication skills.

Responsibilities

• Coordinate and oversee QA activities for the Audit and Reimbursement department.
• Serve as SME in Medicare reimbursement and cost reporting; provide technical leadership.
• Monitor quality through periodic reviews and drive continuous QA improvements.
• Interpret CMS regulations and respond to audit research issues.
• Lead or participate in cross-functional groups to improve documentation and auditing techniques.

Skills

Medicare auditing

Reimbursement analysis

Regulatory compliance

Data analysis

Risk assessment

Project management

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 and oversee QA activities within the Audit and Reimbursement department. This role acts as a subject matter expert in Medicare reimbursement and cost reporting, providing technical leadership and driving QA improvements.

You will monitor quality through reviews, interpret CMS regulations, and support risk assessment and continuous improvement initiatives that protect Medicare funds.