[Hiring] Quality Assurance & Compliance Manager @Nira Medical

Role Description

The Quality Assurance & Compliance Manager will help lead the design, implementation, and ongoing execution of this enterprise quality program, ensuring billing accuracy, regulatory compliance, and revenue integrity across all practice locations. This role is responsible for embedding structured quality controls into operational workflows to proactively mitigate risk and strengthen audit readiness.

• Developing structured audit protocols
• Overseeing compliance inspection frameworks
• Enforcing billing standards
• Managing corrective action processes
• Advancing continuous quality improvement initiatives
• Safeguarding interface and claim integrity
• Ensuring RCM remains compliant with CMS regulations, MAC LCD/NCD policies, Commercial payer requirements, NCCI edit standards, and Internal billing governance protocols

Qualifications

• 7+ years of progressive experience in healthcare revenue integrity, auditing, compliance, or quality management
• Demonstrated experience designing and implementing structured QA/QC or revenue integrity programs in multi-site healthcare environments
• Advanced knowledge of CMS billing regulations, MAC LCD/NCD policies, Commercial payer reimbursement structures, CPT/HCPCS coding standards, Modifier compliance logic, and FDA Indications & Medical Necessity requirements
• Experience in managing audit documentation, corrective action workflows, and compliance governance
• Strong analytical capability with the ability to interpret complex billing data and regulatory guidance
• Executive-level written and verbal communication skills

Requirements

• CPC, CPMA, RHIA, RHIT, or equivalent certification (preferred)
• Experience within neurology, infusion therapy, specialty pharmaceuticals, or other high-complexity service lines (preferred)
• Experience in MSO or multi-practice healthcare platforms (preferred)