Program Specialist - Recovery and Cost Avoidance
About The Position
The Health & Human Services - Agency 25 is seeking a Program Specialist for the Recovery and Cost Avoidance (RCA) unit. This role is crucial in helping Medicaid maximize funds and reduce costs while ensuring members receive necessary healthcare and support. The RCA unit operates under state and federal law, which mandates Medicaid to be the Payer of Last Resort. The unit comprises four programs: Coordination of Benefits (COB), Estate Recovery (ER), Health Insurance Premium Payment Program (HIPP), and Third Party Liability/Casualty (TPL). These programs collectively aim to reduce Medicaid costs for the State of Nebraska. The team is committed to improving efficiencies and achieving 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 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.
Nice To Haves
- A bachelor’s 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.
Responsibilities
- 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
Benefits
- Comprehensive package of pay, benefits, paid time off, retirement and professional development opportunities
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
