Remote Medicare QA Manager: Audit & Reimbursement

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

Benefits offered by this job

Remote work options available

Performance bonus and merit increase

401(k) with full match for first 3% of

salary and 50% match for next 2%

Job summary

WPS, a health solutions company, seeks a Quality Assurance Manager to coordinate QA activities for the Audit and Reimbursement department, focusing on Medicare reimbursement and CMS compliance. You will lead regulatory initiatives and enhance audit documentation while supporting continuous improvement.

Ideal candidates have strong auditing expertise, project management skills, and the ability to interpret complex CMS regulations and apply them to reimbursement scenarios.

Qualifications

• Bachelor’s degree in Accounting, Finance, Business Administration, or related field, or equivalent post high school education and/or work-related experience.
• 5 or more years of progressive experience in Medicare auditing and/or Reimbursement activity.
• Extensive, thorough knowledge of auditing techniques, Government Auditing Standards and Medicare rules and regulations.
• Thorough knowledge and understanding of claims processing and pricing and the PS&R.
• Excellent researching skills and understanding of the types and hierarchy of authoritative sources.
• Demonstrated expertise in complex reimbursement methodologies and cost allocation principles.
• Proven analytical, decision making and judgment abilities.
• Demonstrated skill in group facilitation, project management, data analysis, and risk assessment.
• Strong skills with professional, technical written and verbal communications.

Responsibilities

• Coordinate and oversee the continued development, implementation, and monitoring of Quality Assurance activities for the Audit and Reimbursement department.
• Serve as subject matter expert in Medicare reimbursement and cost reporting; provide technical leadership.
• Lead or participate in work groups and regulatory initiatives to improve audit work papers and documentation.
• Respond to provider inquiries and ensure CMS regulations are interpreted and applied correctly.

Skills

Auditing techniques

Government Auditing Standards

Medicare rules and regulations

Researching skills

Cost allocation principles

Data analysis

Project management

Risk assessment

Written communications

Verbal communications

Education

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

Job description

WPS, a health solutions company, seeks a Quality Assurance Manager to coordinate QA activities for the Audit and Reimbursement department, focusing on Medicare reimbursement and CMS compliance. You will lead regulatory initiatives and enhance audit documentation while supporting continuous improvement.

Ideal candidates have strong auditing expertise, project management skills, and the ability to interpret complex CMS regulations and apply them to reimbursement scenarios.