Remote Senior Overpayment Recovery Lead

WPS Health Solutions; Houston (TX); Remote; USD 27,000 - 39,000; Full time

Benefits offered by this job

Remote work options available

Performance bonus/merit increase

401(k) with 100% match up to 3% and 50

Annual leave/paid time off

Health/dental/telehealth

Job summary

WPS Health Solutions in Texas is seeking a Senior Overpayment Recovery Specialist to support the Overpayment Recovery Team with direction, workflow, and coordination of activities. This role advises staff, mentors new employees, and helps resolve complex recovery issues.

The position requires at least 2 years in Medicare Financial/Overpayment Recovery and familiarity with HIGLAS, audits, and regulatory interpretation. Remote work is possible in several states, with shifts and training provided.

Qualifications

• Two (2) or more years Medicare Financial/Overpayment Recovery experience with proficiency in all overpayment recovery areas, or applicable adjustment experience in other WPS contracts.
• Knowledge of Overpayment Recovery Regulations, including coordination of benefits, financial cash receipts/recovery regulations and procedures, HIGLAS system, claims processing guidelines, edit resolution, and online systems.
• Knowledge of how to interpret regulations and apply them to process manuals, work instructions, and departmental guidelines.
• Knowledge of internal/external audit procedures, quality review standards, and audit documentation requirements.
• In‑depth knowledge of insurance, payment recovery, reimbursement processes, and overpayment case workflow.
• Strong written and verbal communication skills for mentoring staff, preparing reports, and documenting procedures.

Responsibilities

• Assist supervisor with monitoring, working, analyzing, and escalating department workload inventories for timely handling.
• Assist supervisor with mentoring new employees and providing process training.
• Support the preparation of daily, weekly, and monthly operations reports, including those related to Recovery Audit activities.
• Assist with interpretation of regulations and development/revision of work instructions and process manuals.
• Research and respond to complex Overpayment Recovery or financial case situations.
• Perform audits and/or quality reviews of unit completed work.
• Assist with and/or participate in departmental internal and external audit processes, including OMB‑A123, SSAE‑16, ISO Surveillance, and Internal Audit reviews.
• Assist with ensuring jurisdictional process consistency, including process manuals and work instructions. Provide technical assistance by identifying and reporting system problems and testing system changes.
• Ensure compliance with Federal Privacy Act, HIPAA, and WPS conflict of interest and confidentiality requirements within daily work assignments.
• Provide necessary back‑up by performing duties assigned to the Payment Recovery Representative, Payment Recovery Specialist, Reimbursement Analyst, Senior Reimbursement Analyst, and MSP Senior Analyst.
• Other job‑related responsibilities may be assigned as required.

Skills

Mentoring staff

Training others

Communication skills

Education

High School Diploma or equivalent

Tools

HIGLAS system

Job description

WPS Health Solutions in Texas is seeking a Senior Overpayment Recovery Specialist to support the Overpayment Recovery Team with direction, workflow, and coordination of activities. This role advises staff, mentors new employees, and helps resolve complex recovery issues.

The position requires at least 2 years in Medicare Financial/Overpayment Recovery and familiarity with HIGLAS, audits, and regulatory interpretation. Remote work is possible in several states, with shifts and training provided.