Medicare Quality Assurance Lead (Remote)

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

Benefits offered by this job

Remote work options available

Performance bonus

401(k) with company match

Paid time off

Health insurance

Dental insurance

Telehealth services

Leadership development programs

Job summary

WPS is seeking a Quality Assurance Manager to coordinate QA activities for the Audit and Reimbursement department, acting as the Medicare reimbursement SME and leading the ongoing improvement of QA processes. The role emphasizes CMS regulation interpretation, risk assessment, and adherence to Government Auditing Standards.

The successful candidate will guide audits, respond to inquiries, and lead work groups to enhance documentation and testing standards in a remote-capable role across approved

Qualifications

• Bachelor’s degree in Accounting, Finance, Business Administration, or related field, or equivalent post high school education and/or work-related 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 claims processing and PS&R.
• Excellent researching skills and understanding of authoritative sources.
• Demonstrated expertise in complex reimbursement methodologies and cost allocation principles.
• Strong analytical, decision making and judgment abilities.
• Proven ability to lead groups, manage projects, analyze data and assess risk.
• Strong written and verbal communication skills.

Responsibilities

• Coordinate and oversee QA activities for the Audit and Reimbursement department.
• Serve as SME in Medicare reimbursement and cost reporting.
• Lead and participate in cross-functional groups improving work papers and documentation standards.
• Conduct IQC reviews and respond to provider inquiries.
• Facilitate quarterly meetings to discuss IQC findings and regulatory updates.
• Review and approve forms for accuracy and testing.
• Ensure CMS regulations and Medicare rules are applied to complex scenarios.

Skills

Analytical abilities

Communication skills

Project management

Risk assessment

Regulatory interpretation

Decision making

Leadership

Education

Bachelor's degree or equivalent

Tools

Audit software

MS Office

Job description

WPS is seeking a Quality Assurance Manager to coordinate QA activities for the Audit and Reimbursement department, acting as the Medicare reimbursement SME and leading the ongoing improvement of QA processes. The role emphasizes CMS regulation interpretation, risk assessment, and adherence to Government Auditing Standards.

The successful candidate will guide audits, respond to inquiries, and lead work groups to enhance documentation and testing standards in a remote-capable role across approved