Remote Senior Overpayment Recovery Specialist

WPS Health Solutions; Madison (WI); Hybrid; USD 25,000 - 33,000; Full time

Benefits offered by this job

Health insurance

401(k) with match

Remote work options available

Paid time off

Job summary

WPS Health Solutions is seeking a Senior Overpayment Recovery Specialist to guide the Overpayment Recovery Team through workflow, training, and complex case resolution. The role emphasizes mentoring staff, analyzing workload, and supporting governance and audit activities.

You will assist with the development of work instructions, ensure regulatory compliance, and help produce daily to monthly performance reports.

Qualifications

• Two (2) 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 receipts/recovery procedures, HIGLAS system, and claims processing guidelines.
• Knowledge of how to interpret regulations and apply them to process manuals and guidelines.
• Experience with internal/external audit procedures, quality review standards, and audit documentation requirements.
• Ability to train new employees, provide coaching, and support team development.

Responsibilities

• Assist supervisor with monitoring, workload analysis, and escalation for timely handling of department tasks.
• Mentor new employees and provide process training to staff.
• Support preparation of daily, weekly, and monthly operations reports, incl. Recovery Audit activities.
• Interpret regulations and help develop/update work instructions and manuals.
• Research and respond to complex Overpayment Recovery or financial case situations.
• Perform audits/quality reviews of unit output and participate in internal/external audits.
• Ensure compliance with privacy rules and testing of system changes; provide technical assistance as needed.
• Provide back-up for other roles in the department as required.
• Collaborate with cross-functional teams to maintain process consistency.

Skills

Overpayment Recovery

Audit Procedures

Regulatory Knowledge

HIPAA Compliance

Mentoring Staff

Education

High School Diploma

Job description

WPS Health Solutions is seeking a Senior Overpayment Recovery Specialist to guide the Overpayment Recovery Team through workflow, training, and complex case resolution. The role emphasizes mentoring staff, analyzing workload, and supporting governance and audit activities.

You will assist with the development of work instructions, ensure regulatory compliance, and help produce daily to monthly performance reports.