Senior Overpayment Recovery Lead (Remote)

WPS Health Solutions; Monona (WI); Hybrid; USD 37,000 - 42,000; Full time

Benefits offered by this job

Remote work options available

401(k) with match

Health insurance

Paid time off

Telehealth services

Job summary

WPS Health Solutions in Wisconsin seeks a Senior Overpayment Recovery Specialist to support the Overpayment Recovery Team with work direction, workflow, inventory, and coordination of activities. The role advises and assists staff, resolving complex issues and driving timely recovery outcomes.

The position entails mentoring staff, preparing daily/weekly/monthly operations reports, interpreting regulations, supporting audits, and maintaining compliance with Privacy Act and HIPAA.

Qualifications

• High School Diploma or equivalent.
• Two (2) years Medicare Financial/Overpayment Recovery experience with proficiency in all overpayment recovery areas.
• 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.

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 internal and external audit processes, including OMB-A123, SSAE-16, ISO Surveillance, and Internal Audit reviews.

Skills

Communication

Analytical thinking

Mentoring

Training

Audits

Regulatory knowledge

Education

High School Diploma

Job description

WPS Health Solutions in Wisconsin seeks a Senior Overpayment Recovery Specialist to support the Overpayment Recovery Team with work direction, workflow, inventory, and coordination of activities. The role advises and assists staff, resolving complex issues and driving timely recovery outcomes.

The position entails mentoring staff, preparing daily/weekly/monthly operations reports, interpreting regulations, supporting audits, and maintaining compliance with Privacy Act and HIPAA.