Quality Assurance & Compliance Manager
Nira Medical Group
full-time
Posted on:
Location Type: Remote
Location: United States
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About the role
- Help lead the design, implementation, and ongoing execution of the enterprise quality program.
- Ensure billing accuracy, regulatory compliance, and revenue integrity across all practice locations.
- Embed structured quality controls into operational workflows to proactively mitigate risk and strengthen audit readiness.
- Establish and maintain a best-in-class Revenue Integrity Quality Management Program across Nira’s multi-site neurology platform.
- Develop structured audit protocols and oversee compliance inspection frameworks.
- Enforce billing standards and manage corrective action processes.
- Advance continuous quality improvement initiatives and safeguard interface and claim integrity.
- Ensure RCM remains compliant with CMS regulations, MAC LCD/NCD policies, Commercial payer requirements, NCCI edit standards, and Internal billing governance protocols.
Requirements
- 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.
- 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).
Benefits
- Health insurance
- Retirement plans
- Paid time off
- Flexible work arrangements
- Professional development
- Bonuses
- Equipment allowances
- Wellness programs
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
healthcare revenue integrityauditingcompliancequality managementQA/QC program designbilling standards enforcementaudit documentation managementCPT codingHCPCS codingdata analysis
Soft Skills
analytical capabilityexecutive-level communication
Certifications
CPCCPMARHIARHIT