Quality Assurance Manager

WPS Health Solutions New • Madison, WI

9d • Remote

About The Position

Our 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.

Requirements

• 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.
• 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 ).

Nice To Haves

• 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.

Responsibilities

• Consulting with Management in facilitating the development and implementation of Quality Assurance activities as well as consistency monitoring within Medicare Audit and Reimbursement.
• Researching and responding 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 ).
• Responding to audit staff on various audit research issues, performing tertiary review for Nursing and Allied Health (NAH) provider operated programs, and reviewing Organ Acquisition audit scoping.
• Conducting Internal Quality Control (IQC) reviews and issuing an IQC report to Medicare Audit and Reimbursement Management.
• Conducting quarterly meetings with Medicare Audit and Reimbursement Management and Field Audit Supervisors and staff to discuss IQC findings.
• Completing quarterly Reopening and Appeals Reviews ensuring compliance with Medicare regulations.
• Reviewing and approving forms that are created or revised ensuring the forms are accurate and properly tested.
• Responding timely and accurately to provider inquiries and inquiries from other internal and external customers.
• Interpreting and applying CMS regulations, Medicare reimbursement principles, and Government Auditing Standards to complex scenarios.
• Leading or participating in work groups, special projects, regulatory implementation initiatives, and cross-functional collaborations focused on improving work paper guidelines, auditing techniques, and documentation standards.

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

What This Job Offers

• Job Type: Full-time
• Career Level: Manager