Remote Medicare QA Manager: Audit & Reimbursement Lead

WPS Health Solutions; Charleston (SC); Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Remote work options

401(k) with generous match

Performance bonus available

Health and dental insurance

Job summary

WPS Health Solutions is seeking a Quality Assurance Manager to coordinate QA activities in the Audit and Reimbursement department. The role serves as a Medicare reimbursement SME, guiding cost reporting, risk assessment and QA process improvements.

The position requires deep knowledge of Medicare rules, Government Auditing Standards, and PS&R. Remote work is allowed for qualified states with strong leadership and analytical skills.

Qualifications

• Bachelor’s degree or equivalent with strong foundation in accounting, finance or business.
• 5+ years in Medicare auditing or reimbursement activities.
• Extensive knowledge of auditing techniques and Government Auditing Standards.
• Thorough understanding of claims processing, PS&R and Medicare rules.
• Strong research skills and ability to interpret regulatory guidance.

Responsibilities

• Coordinate and oversee QA activities for Audit and Reimbursement.
• Serve as SME in Medicare reimbursement and cost reporting.
• Provide technical leadership and monitor QA quality through reviews.
• Lead development and implementation of QA processes.
• Conduct quarterly IQC reviews and report findings to management.
• Respond to audit inquiries and interpret CMS regulations for complex cases.

Skills

Medicare auditing

Quality Assurance

Data analysis

Risk assessment

Regulatory interpretation

Education

Bachelor's degree in Accounting/Finance/Business

5+ years Medicare experience

Tools

PS&R knowledge

CMS regulations

Job description

WPS Health Solutions is seeking a Quality Assurance Manager to coordinate QA activities in the Audit and Reimbursement department. The role serves as a Medicare reimbursement SME, guiding cost reporting, risk assessment and QA process improvements.

The position requires deep knowledge of Medicare rules, Government Auditing Standards, and PS&R. Remote work is allowed for qualified states with strong leadership and analytical skills.