Contracts & Pricing Execution Mgr

What you will do

• As the Manager, Medicaid – Contracts & Pricing Execution (AIN), you will lead AIN-based execution of U.S. Medicaid rebate operations within the Contracts & Pricing Execution function. This role is responsible for managing Medicaid invoice processing, claim validation, CLD analytics, dispute management, payment package support, reporting, reconciliation, operational controls, documentation, and continuous improvement for a highly regulated U.S. Medicaid operating environment.
• Reporting to the Senior Manager/Director, Contracts & Pricing Execution, you will partner closely with ATO Medicaid process owners, U.S.-based Government Pricing, Finance, Compliance, Contracting, Market Access, Information Systems, and AIN cross-functional teams to ensure accurate, compliant, scalable, and audit-ready Medicaid execution. The role will provide leadership to AIN-based associates and analysts supporting Medicaid operations while preserving appropriate ATO oversight for complex states, judgment-based decisions, approvals, and compliance ownership.
• Key Responsibilities
• Medicaid Operations Management
• Lead end-to-end execution of U.S. Medicaid rebate operations within CPE, covering quarter setup, program readiness, invoice intake, claim loading, invoice validation, CLD processing, disputes, payment package preparation, payment execution support, reporting, and reconciliation.
• Oversee operational delivery for standard-state Medicaid activities transitioning to AIN while ensuring complex-state issues, high-risk exceptions, approvals, and judgment-based decisions are appropriately escalated to ATO retained owners.
• Manage workloads, state portfolios, invoice cycles, open items, exception inventories, dispute aging, payment timelines, and quarter-close deliverables to ensure accurate, timely, and compliant execution.
• Establish operational discipline across trackers, KPI reporting, work allocation, service expectations, quality checks, readiness gates, and issue escalation routines.
• Quarter Setup, Contract / Program Updates & URA Readiness
• Oversee Medicaid program setup and maintenance activities including supplemental program updates, customer/payee readiness, program term changes, and reference data coordination in Model N.
• Coordinate with Government Pricing, Contracting, Finance, Compliance, Information Systems, and ATO Medicaid process owners to ensure pricing, URA publication, and program readiness steps are completed before invoice processing begins.
• Ensure AIN execution teams follow SOP-aligned controls for AWP, URA, program updates, access reviews, and evidence retention, while ATO retains final oversight for complex contract interpretation and pricing/terms risk decisions.
• Invoice Processing, Validation & CLD Analytics
• Lead Medicaid invoice receipt tracking, invoice conversion, Model N upload preparation, and first-pass validation for standard states and repeatable workstreams.
• Oversee validation activities including units, NDC, reimbursement, URA reasonableness, duplicate discount indicators, ESRD/medical benefit considerations, managed care vs. FFS nuances, and state-specific exception logic.
• Drive CLD formatting, claim-level analytics, historical utilization review, trend analysis, and exception documentation to support accurate payment and dispute decisions.
• Ensure complex validation issues, state-specific nuance, high financial exposure, or ambiguous policy interpretation are routed to ATO/US stakeholders with clear evidence and recommendations.
• Dispute Management, Payment Processing & Financial Controls
• Oversee dispute identification, dispute code documentation, dispute tracking, resolution follow-up, interest accrual support, and aging governance across Medicaid invoices and adjustments.
• Lead payment package preparation and review readiness including ROSI, PQAS, remittance support, approval evidence, SAP/Model N reconciliation support, and SharePoint archival documentation.
• Partner with Finance and ATO retained owners to support GL reconciliation, budget-to-actual review, payment variance analysis, dispute rollforward visibility, and quarter-close controls.
• Ensure SOX-aligned documentation, review evidence, and decision logs are maintained for audit readiness and financial control requirements.
• Systems, Automation & Continuous Improvement
• Serve as an AIN business operations lead for Model N, Validata, SAP, state portals, AIR/automation, SharePoint repositories, Tableau/Qlik/Power BI reporting, and related Medicaid workflow tools.
• Partner with Information Systems and ATO process owners on system access readiness, defect resolution, UAT, workflow enhancements, automation opportunities, and process scalability initiatives.
• Drive SOP, work instruction, decision tree, state-specific exception playbook, training material, and knowledge repository development to reduce SME dependency and strengthen repeatable execution.
• Use reporting, dashboards, process metrics, and automation opportunities to improve cycle time, first-pass quality, dispute visibility, and operational transparency.
• People Leadership & Transition Readiness
• Lead, coach, and develop AIN-based Medicaid Associates / Senior Associates supporting Medicaid operations and transition execution.
• Build a structured onboarding and KT model across learning, shadowing, reverse shadowing, supervised execution, and readiness sign-off before independent ownership expands.
• Partner with ATO Medicaid SMEs to define skills, proficiency levels, QA standards, escalation rules, and readiness criteria for each Medicaid process step.
• Create a culture of accountability, compliance, quality, continuous improvement, stakeholder service, and One CPE collaboration across ATO and AIN.
• Compliance, Controls & Audit Readiness
• Ensure compliance with SOX controls, internal policies, pricing governance requirements, audit standards, and applicable pharmaceutical contracting regulations
• Maintain audit-ready documentation, approval evidence, decision logs, dispute records, and process workpapers supporting operational compliance.
• Identify operational, compliance, financial, and data integrity risks and lead mitigation and remediation efforts.
• Support internal, external, and SOX audit activities and drive closure of audit observations.
• What We Expect of You
• We are all different, yet we all use our unique contributions to serve patients. The ideal candidate is a strong Medicaid / managed markets operations leader with experience in U.S. healthcare or pharmaceutical rebate operations, financial controls, systems enablement, and people leadership. This individual combines operational discipline, Medicaid domain knowledge, analytical rigor, stakeholder collaboration, and a continuous improvement mindset to build a scalable AIN Medicaid capability.
• Basic Qualifications
• Master’s degree in finance, Accounting, Commerce, Business Administration, Economics, Life Sciences, Pharmacy, or related discipline.
• 9–12 years of progressive experience in pharmaceutical / biotech operations, managed markets, Medicaid rebate operations, revenue management, finance, pricing, contracting, analytics, or related U.S. healthcare operations.
• 3+ years of experience leading people, managing operational teams, or leading complex cross-functional delivery in a controlled environment.
• Experience operating with U.S.-based stakeholders across Finance, Market Access, Government Pricing, Compliance, IT, or Contract Operations.
• 3+ years of experience leading people or managing operational teams.
• Experience coordinating structured work across reporting, systems/process support, documentation, controls, or related business operations activities.
• Preferred Qualifications
• Deep understanding of U.S. Medicaid Drug Rebate Program operations, Medicaid rebate adjudication, supplemental rebates, CLD processing, dispute management, ROSI/PQAS, and payment package requirements.
• Experience with Model N Revenue Management / PbN, Validata, Revitas Flex, SAP, SharePoint, Tableau, Qlik, Power BI, Power Query, Alteryx, or comparable revenue management and analytics platforms.
• Working knowledge of AMP, Best Price, URA, AWP, NDC, 340B duplicate discount concepts, managed care utilization, ESRD/medical claims considerations, and Gross-to-Net operations.
• Experience supporting SOX controls, audit readiness, SOP/work instruction documentation, access reviews, issue management, UAT, and system enhancement activities.
• Proven ability to lead transition, KT, process standardization, automation, reporting, and continuous improvement initiatives in a distributed global operating model.
• Strong stakeholder management, communication, influencing, escalation management, analytical, and executive-ready reporting skills.