Program Specialist Recovery and Cost Avoidance

The work we do matters!

Hiring Agency:

Health & Human Services - Agency 25

Location:

Lincoln NE

Hiring Rate:

$24.862

Job Posting:

JR2026- Program Specialist - Recovery and Cost Avoidance (Open)

Applications No Longer Accepted On (If no date is displayed job is posted as open until closed):

0

Job Description:

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 - lets make a difference for Nebraskans!

Examples of Work:

A Program Specialist on the RCA team will have opportunity to:

• Review of health insurance benefit plans 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 administration 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 and service providers

• Research and develop program policy and perform quality assurance analysis and evaluation of assigned program(s)

• Perform related duties as assigned

Hire Rate: $24.862 per 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: Bachelors degree or equivalent coursework/training in public administration social/behavioral sciences healthcare human services or other program related field. Professional experience working in a human/social service or health care agency with responsibility for planning or evaluation services programs or operational policies and practices may substitute in lieu of the educational requirement. Familiarity with Microsoft Office Teams Excel PowerPoint or similar tools.

Preferred Qualifications:

• A bachelors degree in social sciences education or a related field is preferred.

• Experience with medical claims/insurance claim coordination medical office administration.

• Experience reading/interpreting insurance policies.

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.

Skill in: interpreting and/or clarifying policy to interested groups; conducting formal presentations to provide education and share information.

Ability 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.

If youre currently employed by the State of Nebraska please dont apply through this external career site. Instead log in to Workday and open the Jobs Hub - Internal Apply app from your home landing page. You can access Workday anytime through the Link web page: offer a comprehensive package of pay benefits paid time off retirement and professional development opportunities to help you get the most out of your career and life. Your paycheck is just part of your total compensation.

Check out all that the State of Nebraska has to offer! Benefit eligibility may vary by position agency and employment status. For more information on benefits please visit: Opportunity Statement

The State of Nebraska values our teammates as well as a supportive environment that strives to promote diversity inclusion and belonging. We recruit hire train and promote in all job classifications and at all levels without regard to race color religion sex. age national origin disability marital status or genetics.