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.
Salary Range $85,000 ~ $115,000
The base pay offered for this position may vary within the posted range based on
your job-related knowledge, skills, experience, and may fall outside of this pay
range.
Work Location
We are open to remote work in the following approved states:
Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota,
Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas,
Virginia, Wisconsin
How do I know this opportunity is right for me? If you:
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.
Minimum 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.
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 [https://speedtest.net]).
Please review Remote Worker FAQs
[https://secure.wpsic.com/files/remote-work-faqs.pdf] for additional
information.
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
Review additional benefits: (https://www.wpshealthsolutions.com/careers/
[https://www.wpshealthsolutions.com/careers/])
Who We Are
WPS, a health solutions company,
[https://www.wpshealthsolutions.com/about/index.shtml] is a leading
not-for-profit health insurer and federal government contractor headquartered in
Madison, Wisconsin. WPS offers health insurance plans for individuals, families,
seniors and group health plans for small to large businesses. We process claims
and provide customer support for beneficiaries of the Medicare program and
manage benefits for millions of active-duty and retired military personnel
across the U.S. and abroad. WPS has been making healthcare easier for the people
we serve for nearly 80 years [https://www.wpshealthsolutions.com/75/]. Proud to
be military and veteran ready.
Culture Drives Our Success
WPS’ culture is where the great work and innovations of our people are seen,
fueled and rewarded. We accomplish this by creating an open and empowering
employee experience. We recognize the benefits of employee engagement as an
investment in our workforce—both current and future—to effectively seek,
leverage, and include differing and unique perspectives that fuel agility and
innovation on high-performing teams. This results in people bringing their
authentic selves to work every day in an organization that successfully adapts
to business changes and new opportunities.
We are proud of the recognition we have received from local and national
organization regarding our culture and workplace: WPS Newsroom - Awards and
Recognition. [https://www.wpshealthsolutions.com/news/?c=awards]
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This position supports services under Centers for Medicare & Medicaid Services
(CMS) contract(s). As such, the role is subject to all applicable federal
regulations, CMS contract requirements, and WPS internal policies, including but
not limited to standards for data security, privacy, confidentiality, and
program integrity. CMS contractors and their personnel are subject to screening
and background investigation including fingerprinting prior to being granted
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