Role Snapshot
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.
Additional Information
- Starting Base Salary: $ 24.00/hr. (may change with experience)
- Training Location/Schedule:
- Formal training first two weeks, with non-formal training after. Training shift is either 7:30am-4pm CT or 8am-4:30am CT.
- Scheduled Shift: Production hours 6am-8pm CT. 8-hour shift within this time frame.
- We are open to remote work in the following approved states:
Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin
How do I know this opportunity is right for me? If you enjoy the following:
- 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.
Minimum Qualifications
- High School Diploma or equivalent.
- 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.
- 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.
Preferred Qualifications
- Previous experience in a formal or informal leadership capacity, including but not limited to providing guidance, coaching, mentoring, or supporting team members.
Remote Work Requirements
- 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).
- Please review Remote Worker FAQs for additional information.
Benefits
- Remote work options available
- Performance bonus and/or merit increase opportunities
- 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
- Competitive paid time off
- Health insurance, dental insurance, and telehealth services start DAY 1
- Professional and Leadership Development Programs
- Review additional benefits: (https://www.wpshealthsolutions.com/careers/)
Who We Are
WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.
Culture Drives Our Success
WPS’ culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce—both current and future—to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.
We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition.
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Medicare (GHA)
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
Equal Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThis employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
Skills Required
- High school diploma or equivalent
- Two or more years of Medicare financial or overpayment recovery experience, or applicable adjustment experience in other WPS contracts
- Proficiency in overpayment recovery areas
- Knowledge of overpayment recovery regulations, coordination of benefits, financial cash receipts and recovery procedures, HIGLAS, claims processing guidelines, edit resolution, and online systems
- Knowledge of interpreting regulations and applying them to process manuals, work instructions, and departmental guidelines
- Knowledge of internal and 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
- Ability to research and resolve complex financial or recovery-related cases using 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
- Previous formal or informal leadership experience, including guidance, coaching, mentoring, or team support
- Wired Ethernet internet connection, high-speed cable or fiber internet, and minimum internet speeds of 10 Mbps downstream and 1 Mbps upstream for remote work
What We Do
WPS Health Solutions is celebrating 75 years in business as a highly regarded government contractor and leader in the insurance industry. In 2021, the Wisconsin State Journal named WPS as a Top Workplace in the Madison area. WPS has several divisions committed to delivering high-quality service to our customers. - WPS Health Insurance and WPS Health Plan offer affordable health plans for individuals, small businesses, and large businesses, plus benefits administration. - WPS Government Health Administrators administers Part A and Part B Medicare benefits—services we have provided since the program’s inception—for millions of seniors in multiple states. - WPS Military and Veterans Health serves millions more beneficiaries who are active in the U.S. military, veterans, and their families. - EPIC Specialty Benefits has offered voluntary nonmedical benefits, such as term life, disability, dental, and vision, for more than 35 years. WPS also actively partners with nonprofit organizations to help make lasting changes in the communities we serve, with an emphasis on health issues, especially for military and veterans, women, and children.
