The role will partner with the Medicaid Manager, AIN team members, ATO Medicaid process owners, Government Pricing, Finance, Compliance, Contracting, Information Systems, and other U.S.-based stakeholders to support accurate, timely, and compliant Medicaid operations. The Associate will be expected to learn Medicaid processes through structured KT, shadowing, reverse shadowing, and supervised execution before taking on broader independent responsibilities.
Key Responsibilities
Medicaid Processing & Operational Execution
Support day-to-day execution of Medicaid rebate operations including invoice receipt tracking, invoice conversion, Model N upload preparation, claim processing, payment package support, and documentation maintenance.
Execute assigned standard-state activities in accordance with SOPs, work instructions, checklists, quality standards, and established timelines.
Maintain accurate trackers for invoice status, CLD receipt, validation outcomes, open items, dispute status, payment package readiness, and evidence retention.
Flag risks, missing information, aged items, access issues, or process exceptions to the Medicaid Manager and ATO retained owners.
Invoice Validation & CLD Support
Perform first-pass invoice validation checks for assigned Medicaid states, including unit, NDC, reimbursement, URA, invoice, and source data reasonableness checks.
Support CLD formatting, control checks, historical utilization comparison, duplicate discount screening support, and preparation of analysis files for review.
Document validation findings, assumptions, supporting evidence, and required follow-up actions clearly and consistently.
Escalate complex state nuances, high-risk exceptions, unusual utilization trends, or ambiguous payment/dispute issues for manager or ATO review.
Dispute, Adjustment & Payment Package Support
Prepare dispute documentation, dispute tracking updates, response support, and evidence files for disputed units and rebate amounts.
Support preparation of ROSI, PQAS, remittance, payment package, and SharePoint archival documentation in accordance with SOP requirements.
Assist with prior quarter adjustments, supplemental claim support, interest calculation evidence, and payment reconciliation support as assigned.
Maintain clean audit trails, decision logs, and supporting workpapers for Medicaid invoice and payment activities.
Systems, Documentation & Continuous Improvement
Use Model N / PbN, SAP, Validata, SharePoint, state portals, reporting tools, and Microsoft 365 applications to support Medicaid workflow execution.
Assist with UAT, defect documentation, access readiness tracking, SOP updates, work instruction drafting, training material preparation, and knowledge repository maintenance.
Participate in KT, shadowing, reverse shadowing, and supervised execution activities to build Medicaid process proficiency.
Identify process gaps, manual effort reduction opportunities, recurring exceptions, documentation gaps, and quality improvement ideas.
Compliance, Controls & Audit Readiness
Execute work in accordance with internal policies, Medicaid SOPs, controlled process requirements, documentation standards, and compliance expectations.
Maintain accurate evidence for invoice receipt, validation, disputes, payment support, approvals, reconciliations, and archival steps.
Escalate data integrity, compliance, financial, or operational risks promptly and support remediation activities as assigned.
Support audit, SOX, and control review activities by providing complete workpapers and organized documentation.
What We Expect of You
We are all different, yet we all use our unique contributions to serve patients. The ideal candidate is a detail-oriented Medicaid / managed markets operations professional with strong analytical, documentation, and process execution capabilities. This individual should bring ownership, accuracy, curiosity, stakeholder collaboration, and a continuous improvement mindset to support compliant and timely Medicaid rebate execution.
Basic Qualifications
Bachelor’s or Master’s degree in Finance, Accounting, Commerce, Business Administration, Economics, Life Sciences, Pharmacy, or related discipline.
2–5 years of experience in pharmaceutical / healthcare operations, managed markets, Medicaid rebates, finance operations, revenue management, claims operations, analytics, or related controlled business operations.
Strong Excel, documentation, reporting, analytical, and follow-through skills.
Ability to manage multiple priorities, meet timelines, follow SOPs, and work effectively in a deadline-driven and highly controlled environment.
Preferred Qualifications
Exposure to Medicaid rebate operations, payer rebates, managed markets finance, claims validation, CLD processing, dispute tracking, rebate adjudication, Gross-to-Net, or pharmaceutical revenue management.
Experience with Model N / PbN, Validata, Revitas Flex, SAP, SharePoint, Tableau, Qlik Sense, Power BI, Power Query, Alteryx, Power Automate, or comparable tools.
Understanding of NDC, AMP, Best Price, URA, AWP, ROSI, PQAS, 340B duplicate discount concepts, managed care utilization, and compliance documentation is desirable.
Experience supporting SOPs, WSIs, audit-ready workpapers, issue trackers, UAT, system implementation, automation, or process improvement activities.
Strong collaboration, communication, problem-solving, attention to detail, and ability to work with U.S.-based stakeholders in a distributed global operating model.
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