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 tot his job Apply To this Job