Medicaid RCA Program Specialist: Cost Avoidance

Nebraska Department of Health and Human Services; Lincoln (NE); On-site; USD 33,000 - 37,000; Full time

Benefits offered by this job

Comprehensive pay and benefits package

Job summary

Nebraska Department of Health and Human Services in Lincoln, NE is seeking a Program Specialist for the Recovery and Cost Avoidance (RCA) unit. The role focuses on maximizing Medicaid funds and reducing costs, coordinating with clients, providers, attorneys, and insurers to ensure proper payer decisions.

The RCA team works on COB, Estate Recovery, HIPP, and Third Party Liability to avoid costs and recover funds, with a strong emphasis on policy development, QA, and cross‑agency collaboration.

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.

Responsibilities

• Review explanations of benefits and claims history, verify and issue reimbursements.
• Plan and coordinate development and evaluation of statewide health and human services programs.
• Provide technical assistance and guidance to agency staff, clients, and service providers.
• Research and develop program policy and perform QA analysis and evaluation of programs.
• Perform related duties as assigned.

Skills

Communication skills

Public administration knowledge

Policy interpretation

Education

Bachelor's degree or equivalent coursework

Tools

MMIS

N-Focus

OnBase

Microsoft Office

Teams

Excel

PowerPoint

Job description

Nebraska Department of Health and Human Services in Lincoln, NE is seeking a Program Specialist for the Recovery and Cost Avoidance (RCA) unit. The role focuses on maximizing Medicaid funds and reducing costs, coordinating with clients, providers, attorneys, and insurers to ensure proper payer decisions.

The RCA team works on COB, Estate Recovery, HIPP, and Third Party Liability to avoid costs and recover funds, with a strong emphasis on policy development, QA, and cross‑agency collaboration.