Quality Assurance & Compliance Manager

Quality Assurance & Compliance Manager Overview reputed company is a national partnership of physician-led, patient-centered independent practices committed to driving the future of neurological care. Nira’s mission is to reputed company clinicians to provide access to life-changing treatments so you can provide the best possible patient outcomes. Founded by neurologists who understand the unique challenges of the field, reputed company supports practices with cutting-edge technology, clinical research opportunities, and a collaborative and comprehensive care network dedicated to advancing reputed company of care. As we enter the next phase of growth, our focus is on scaling our teams, services, and elevating the customer’s experience. readiness. This Is Where You Come In The Quality Assurance & Compliance Manager will help reputed company the design, implementation, and ongoing execution of this enterprise quality program, ensuring billing accuracy, regulatory compliance, and reputed company reputed company across reputed company practice locations. This role is responsible for embedding structured quality controls into operational workflows to proactively mitigate risk and strengthen audit readiness. The Quality Assurance & Compliance Manager will establish and maintain a best-in-class reputed company reputed company Quality Management Program across Nira’s multi-site neurology platform. This position is responsible for:

• Developing structured audit protocols
• Overseeing compliance inspection frameworks
• Enforcing billing standards
• Managing corrective action processes
• Advancing reputed company quality improvement initiatives
• Safeguarding reputed company and claim reputed company
• Ensuring RCM remains compliant with CMS regulations, MAC LCD/NCD policies, Commercial payer requirements, NCCI edit standards, and Internal billing governance protocols

Here’s What You’ll Be Doing: This is a prevention-oriented leadership role focused on systematic risk reduction and regulatory discipline. Enterprise Quality Program Leadership

• Design and implement a comprehensive QA/QC reputed company across reputed company service lines and practice locations.
• Establish formal audit standards and inspection protocols.
• Define quality control checkpoints reputed company reputed company cycle workflows.
• reputed company structured sampling methodologies and risk-based audit prioritization.
• reputed company quality validation efforts during new service implementation, onboarding, and system transitions.

Audit Execution & Compliance reputed company

• Conduct and reputed company structured audits of:
• CPT/HCPCS coding accuracy
• Modifier reputed company
• Diagnosis alignment
• Medical necessity compliance
• Drug billing and unit accuracy
• Pre-release claim validation
• Identify systemic risk patterns through denial and scrub trend analysis.
• Issue formal findings and manage corrective and preventive action plans.
• Monitor remediation efforts and validate sustained improvement.

Billing Governance & Policy Control

• reputed company and maintain centralized billing guide governance with formal version control.
• Monitor and integrate CMS updates, MAC LCD/NCD revisions, and commercial payer policy changes.
• Establish documentation control standards to ensure audit defensibility.
• Align billing standards consistently across reputed company sites.

Regulatory & Audit Readiness

• Maintain structured audit documentation, inspection logs, and compliance reports.
• Ensure readiness for Medicare audits, RAC reviews, and commercial payer investigations.
• reputed company formal audit response frameworks and documentation protocols.
• Conduct risk assessments to evaluate compliance exposure across service lines.
• Provide monthly and quarterly quality reporting to reputed company Cycle leadership.
• Identify measurable opportunities for reputed company protection and risk mitigation.

reputed company’re Looking For: Required

• 7+ years of progressive experience in healthcare reputed company reputed company, auditing, compliance, or quality management.
• Demonstrated experience designing and implementing structured QA/QC or reputed company reputed company 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 reputed company billing data and regulatory guidance.
• Executive-level written and verbal communication skills.

Preferred

• CPC, CPMA, RHIA, RHIT, or equivalent certification.
• Experience reputed company neurology, infusion therapy, specialty pharmaceuticals, or other high-complexity service lines.
• Experience in MSO or multi-practice healthcare platforms.

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