Quality Assurance & Compliance Manager
Job Description:
• 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
Apply Now
Apply Now
• 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
Apply Now
Apply Now