Senior Overpayment Recovery Lead - Remote

WPS Health Solutions; Green Bay (WI); A distancia; USD 27.000 - 39.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Remote work options available

Performance bonus

401(k) with company match

Health insurance

Descripción de la vacante

WPS Health Solutions in Wisconsin seeks a Senior Overpayment Recovery Specialist to join the Overpayment Recovery Team. You will provide work direction, monitor workload, mentor staff, and coordinate complex cases to ensure timely resolution.

Responsibilities include preparing operational reports, interpreting regulations, supporting audits (OMB-A123, SSAE-16, ISO), and maintaining privacy and HIPAA compliance. Remote work is available in approved states with training provided.

Formación

• 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.
• Skilled in researching and resolving complex financial or recovery‑related case situations with sound judgment.
• Ability to train new employees, provide ongoing coaching, and support team development.
• Ability to collaborate effectively in internal and external audit activities and support cross‑functional teams.

Responsabilidades

• 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.

Descripción del empleo

WPS Health Solutions in Wisconsin seeks a Senior Overpayment Recovery Specialist to join the Overpayment Recovery Team. You will provide work direction, monitor workload, mentor staff, and coordinate complex cases to ensure timely resolution.

Responsibilities include preparing operational reports, interpreting regulations, supporting audits (OMB-A123, SSAE-16, ISO), and maintaining privacy and HIPAA compliance. Remote work is available in approved states with training provided.