Remote QA Manager - Medicare & CMS Compliance Leader

WPS Health Solutions; Detroit (MI); Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Remote work options

Performance bonus

401(k) matching

Paid time off

Health and dental insurance

Job summary

WPS Health Solutions is seeking a Quality Assurance Manager to guide QA activities for the Audit and Reimbursement department, serving as SME in Medicare reimbursement and cost reporting.

You will lead QA process development, monitor compliance with CMS regulations, and drive continuous improvement through reviews and cross-functional collaboration. Remote-work options may be available in approved states.

Bachelor's degree and 5+ years Medicare auditing experience preferred.

Qualifications

• Bachelor's degree in Accounting, Finance, Business Administration, or related field, or equivalent experience.
• 5+ years of Medicare auditing/reimbursement experience.
• Extensive knowledge of auditing techniques, Government Auditing Standards, and Medicare rules.
• Thorough knowledge of claims processing and PS&R.
• Strong researching skills and understanding of authoritative sources.
• Expertise in complex reimbursement methodologies and cost allocation.
• Proven analytical, decision-making and judgment abilities.
• Skill in group facilitation, project management, data analysis, and risk assessment.
• Strong written and verbal communications.

Responsibilities

• Coordinate development, implementation, and monitoring of QA activities for Audit and Reimbursement.
• Serve as SME in Medicare reimbursement and cost reporting; provide technical leadership.
• Monitor quality via periodic reviews and improve QA processes.
• Ensure adherence to CMS regulations and audits.
• Lead or participate in cross-functional work groups and regulatory initiatives.
• Respond to audit staff and internal/external inquiries.
• Conduct IQC reviews and report findings to management.
• Lead quarterly meetings on IQC findings and Reopening/Appeals reviews.

Skills

Analytical skills

Decision making

Communication skills

Research skills

Group facilitation

Project management

Data analysis

Risk assessment

CMS regulations

Education

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

Tools

PS&R knowledge

Job description

WPS Health Solutions is seeking a Quality Assurance Manager to guide QA activities for the Audit and Reimbursement department, serving as SME in Medicare reimbursement and cost reporting.

You will lead QA process development, monitor compliance with CMS regulations, and drive continuous improvement through reviews and cross-functional collaboration. Remote-work options may be available in approved states.

Bachelor's degree and 5+ years Medicare auditing experience preferred.