Remote Senior Overpayment Recovery Lead

WPS—A health solutions company; Texas; Remote; USD 27,000 - 39,000; Full time

Benefits offered by this job

Remote options

Performance bonus

401(k) match

Health insurance

Dental insurance

Telehealth

Job summary

WPS Health Solutions seeks a Senior Overpayment Recovery Specialist to support the Overpayment Recovery Team with work direction, workflow, and coordination of activities within the department. The role also mentors staff and assists with process training.

Responsibilities include preparing operations reports, interpreting regulations, and assisting with audits (OMB-A123, SSAE-16, ISO). Remote work is available for approved states including TX.

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.
• Demonstrated 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.
• Ability to train new employees, provide ongoing coaching, and support team development.

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

Medicare Overpayment Recovery

Regulatory interpretation

Audit procedures

Mentoring staff

Communication skills

Training staff

Team collaboration

Education

High School Diploma or equivalent

Tools

HIGLAS system

Online systems

Job description

WPS Health Solutions seeks a Senior Overpayment Recovery Specialist to support the Overpayment Recovery Team with work direction, workflow, and coordination of activities within the department. The role also mentors staff and assists with process training.

Responsibilities include preparing operations reports, interpreting regulations, and assisting with audits (OMB-A123, SSAE-16, ISO). Remote work is available for approved states including TX.