Program Specialist - Recovery and Cost Avoidance

Program Specialist - Recovery and Cost Avoidance (Open)

Are you interested in helping Medicaid maximize funds and reduce Medicaid costs while working to ensure members get needed healthcare and support? State and federal law requires Medicaid to be the Payer of Last Resort. The Recover and Cost Avoidance (RCA) unit works with clients, providers, attorneys, insurers, and others to reduce the cost of Medicaid to citizens of the State of Nebraska. We accomplish this through four separate programs designed to support this aim:

Coordination of Benefits (COB): This team adds, verifies and maintains health insurance information of all Medicaid-eligible clients; allowing claims to process and pay timely. They also work with private Long-Term Care (LTC) insurers of Medicaid eligible clients to cover the client' LTC services. This team cost avoided $2.7 million in total funds SFY2026.

Estate Recovery (ER): This team is responsible for pursuing and recovering eligible Medicaid payments when assets exist after a client passes away. This team recovered $8.9 million in total funds in SFY2026.

Health Insurance Premium Payment Program (HIPP): The HIPP program pays for health insurance premiums of Medicaid-eligible individuals if it is cost-effective for the State. If it costs Medicaid less to cover the equivalent set of services through the private health plan, then it is considered cost-effective. This team cost-avoided $4.7 Million in SFY2026.

Third Party Liability /Casualty (TPL): This team is responsible for ensuring Medicaid is the payer of last resort on all fee-for-service casualty and health claims when liability exists by other parties or insurance companies. This team recovered and cost avoided approximately $3.7 Million in SFY2026.

Be a member of a team committed to improving efficiencies and tackling goals that support the Nebraska Medicaid mission to Help people live better lives. "You have the passion; we have the opportunities let's make a difference for Nebraskans"

Examples of Work

• Review explanation of benefits and medical and pharmacy claims history, financial and payment documentation, as well as verifying, approving and issuing reimbursements
• Plan and coordinate the development, efficiencies, and evaluation of statewide health and human services program(s)
• Serve as a resource and consultant to provide technical assistance/advice to agency staff, clients, lawyers and service providers
• Research and develop program policy and perform quality assurance analysis and evaluation of assigned program(s)
• Perform related duties as assigned

Salary/Compensation: $24.862/ hour non-exempt

Work Schedule: 40 hours per week. Monday Friday; 8:00 AM 5:00 PM

Dress Attire: Business Casual

Location: Nebraska State Office Building Lincoln

Requirements / Qualifications:

Minimum Qualifications: Bachelor's degree, or equivalent coursework/training, in public administration, social/behavioral sciences, healthcare, human services or another related field. Professional experience working in a human/social service, health care agency or setting with responsibility for planning or evaluation services, programs or operational policies and practices may substitute in lieu of the educational requirement.

Preferred Qualifications:

• A bachelor's degree in social sciences, education, or a related field is preferred
• Experience with accounting, strong organizational, multi-tasking skills, and excellent customer service
• Experience working with multiple databases. Specifically: MMIS, N-Focus, OnBase
• Familiarity with estate settlement, special needs trusts, and annuities
• Familiarity with Microsoft Office, Teams, Excel, PowerPoint, or similar tools.

Knowledge Skills and Abilities:

Knowledge of: The principles and practices of public administration; procedure and policy development; methods and techniques of program planning; federal and state laws, rules, regulations and procedures pertaining to health and human services programs; public funds and budgeting methods; the principles and techniques of adult learning; quality assurance mechanisms; principles and techniques of planning, monitoring and evaluating human services programs and service delivery systems.

Skills in: Interpreting and/or clarifying policy to interested parties; conducting presentations to provide education and share information.

Able to: Plan, organize and direct a major program; work collaboratively in a team setting; analyze, develop and organize materials; establish and maintain positive relationships with agency staff, service providers/contractors, community organizations and clients; communicate electronically, on paper or in person to promote, explain, discuss, advise and interact with interested groups on various program issues and problems; prepare and review technical documents such as summaries of state and federal regulations, action plans, reports, contracts and grants; understand, interpret and apply instructions, laws, rules, policies and procedures pertinent to the program; exercise independent critical thinking skills; maintain liaison with community representatives and other governmental agencies.

Nebraska Government