Senior Overpayment Recovery Lead (Remote)

WPS—A health solutions company; South Carolina; Remote; USD 27.000 - 39.000; Vollzeit

Benefits dieser Stelle

Remote work options available

Performance bonus/merit increases

401(k) with match

Zusammenfassung

WPS Health Solutions is seeking a Senior Overpayment Recovery Specialist to join the team. You will guide work direction, manage workflow, mentor staff, and coordinate activities within the department to resolve complex overpayment cases.

You will assist with preparing regular operational reports, interpret regulations, and contribute to process manuals and audits, including CMS/SSA/ISO reviews. Remote work is permitted in many states; productive collaboration is essential.

Qualifikationen

• 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.

Aufgaben

• 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 related recovery roles.
• Other job-related responsibilities may be assigned as required.

Kenntnisse

Overpayment recovery

Regulatory knowledge

Audit procedures

Communication skills

Training staff

Team collaboration

Ausbildung

High School Diploma or equivalent

Tools

HIGLAS system

Online systems

Jobbeschreibung

WPS Health Solutions is seeking a Senior Overpayment Recovery Specialist to join the team. You will guide work direction, manage workflow, mentor staff, and coordinate activities within the department to resolve complex overpayment cases.

You will assist with preparing regular operational reports, interpret regulations, and contribute to process manuals and audits, including CMS/SSA/ISO reviews. Remote work is permitted in many states; productive collaboration is essential.