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.
Identify process exceptions, missing data, aging items, and operational risks and escalate appropriately.
Invoice Validation & CLD Support
Perform invoice and utilization validation activities including review of units, NDCs, URAs, reimbursement values, utilization trends, and source data integrity
Conduct rebate analysis and reasonableness checks through historical utilization comparisons, trend analysis, and exception identification.
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.
Support 340B duplicate discount screening activities and validation of rebate-related data.
Investigate discrepancies and prepare supporting analysis for review and resolution.
Dispute, Adjustment & Payment Package Support
Research rebate disputes and support preparation of documentation, supporting evidence, and response packages for state Medicaid agencies.
Support prior-quarter adjustments, supplemental rebate activities, payment calculations, and reconciliation processes.
Prepare payment package documentation and maintain complete audit trails supporting rebate payments and adjustments.
Maintain accurate dispute logs, decision documentation, and supporting workpapers.
Systems, Documentation & Continuous Improvement
Utilize Model N/PbN, SAP, Validata, SharePoint, state portals, and reporting tools to support Medicaid rebate operations.
Prepare routine and ad-hoc operational reporting, trend analyses, KPI metrics, and management summaries.
Support user acceptance testing (UAT), process enhancements, SOP updates, and system improvement initiatives.
Identify opportunities to improve efficiency, strengthen controls, reduce manual effort, and enhance process quality.
Compliance, Controls & Audit Readiness
Execute work in accordance with internal policies, Medicaid SOPs, controlled process requirements, documentation standards, and compliance expectations.
Maintain audit-ready documentation supporting invoice processing, validations, disputes, approvals, reconciliations, and payment activities
Support SOX, internal audit, compliance reviews, and control testing activities.
Identify and escalate compliance, financial, operational, and data integrity risks to appropriate stakeholders.
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.
4 - 7 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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