Program Specialist - Recovery and Cost Avoidance

State of Nebraska•Lincoln, NE

9d•Onsite

About The Position

The Recovery 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), Estate Recovery (ER), Health Insurance Premium Payment Program (HIPP), and Third Party Liability /Casualty (TPL). The Program Specialist will 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.

Requirements

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.

Nice To Haves

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 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.

Responsibilities

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