[Hiring] Quality Assurance Manager @WPS—A health solutions company

Role Description

The Quality Assurance Manager coordinates and oversees the continued development, implementation, and monitoring of the Quality Assurance activities for the Audit and Reimbursement department. They serve as a subject matter expert in Medicare reimbursement and cost reporting, provide technical leadership, monitor quality through periodic reviews, and facilitate ongoing development and implementation of the Quality Assurance process. This QA Manager ensures adherence to the regulations of the Centers for Medicare and Medicaid Services (CMS). They play a critical role in risk assessment, Medicare regulation interpretation, and continuous improvement initiatives that support responsible stewardship of Medicare funds.

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, practices and issues, Government Auditing Standards and Medicare rules and regulations.
• Thorough knowledge and understanding of claims processing and pricing and the Provider Statistical and Reimbursement Report (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.

Requirements

• Enjoy consulting with Management in facilitating the development and implementation of Quality Assurance activities as well as consistency monitoring within Medicare Audit and Reimbursement.
• Like to research and respond to issues by developing rebuttals for each issue found during the annual Quality Assurance Surveillance Plan (QASP) reviews completed for Medicare Administrative Contractor (MAC) contracts (J5 and J8).
• Can respond to audit staff on various audit research issues, perform tertiary review for Nursing and Allied Health (NAH) provider operated programs, and review Organ Acquisition audit scoping.
• Have conducted Internal Quality Control (IQC) reviews and issued an IQC report to Medicare Audit and Reimbursement Management.
• Would like to conduct quarterly meetings with Medicare Audit and Reimbursement Management and Field Audit Supervisors and staff to discuss IQC findings.
• Want to complete quarterly Reopening and Appeals Reviews ensuring compliance with Medicare regulations.
• Have reviewed and approved forms that are created or revised ensuring the forms are accurate and properly tested.
• Can respond timely and accurately to provider inquiries and inquiries from other internal and external customers.
• Like to interpret and apply CMS regulations, Medicare reimbursement principles, and Government Auditing Standards to complex scenarios.
• Can lead or participate in work groups, special projects, regulatory implementation initiatives, and cross-functional collaborations focused on improving work paper guidelines, auditing techniques, and documentation standards.

Preferred Qualifications

• 7 or more years of progressive experience in Medicare auditing and/or Reimbursement activity.
• Significant experience with audit methodologies, financial analysis, and regulatory compliance.
• A strong affinity to technical documentation and healthcare writing.

Remote Work Requirements

• Wired (ethernet cable) internet connection from your router to your computer.
• High speed cable or fiber.
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net ).

Benefits

• Remote work options available.
• Performance bonus and/or merit increase opportunities.
• 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately).
• Competitive paid time off.
• Health insurance, dental insurance, and telehealth services start DAY 1.
• Professional and Leadership Development Programs.