Senior Overpayment Recovery Specialist

WPS Health Solutions New • Madison, WI

13d • Remote

About The Position

The Senior Overpayment Recovery Specialist will assist the Overpayment Recovery Team with work direction, workflow, inventory, and coordination of activities and processes within the department. The role will advise and assist employees in the unit and support the resolution of difficult or complex issues. This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). As such, the role is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. CMS contractors and their personnel are subject to screening and background investigation including fingerprinting prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services.

Requirements

• High School Diploma or equivalent.
• 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 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.
• Wired (ethernet cable) internet connection from your router to your computer.
• High speed cable or fiber internet.
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net ).

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.

Benefits

• Performance bonus and/or merit increase opportunities
• 401(k) with dollar-per-dollar match up to 6% of salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Employee Resource Groups
• Professional and Leadership Development Programs

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED