Senior Manager, Medicaid Operations

OperationsOperationsFull TimeRemoteTeam 5,001-10,000H1B SponsorCompany SiteLinkedIn

Location

Massachusetts

Posted

40 days ago

Salary

$140K - $187K / year

Bachelor Degree5 yrs expEnglish

Job Description

• Lead the Medicaid team’s efforts to develop processes and controls to identify, investigate, and resolve 340B duplicate discounts. • Leverage data to guide 340b inquiries and enhance operational controls. • Work with internal stakeholders to develop methodologies to detect potential duplicate discounts using state-claim-level data, HRSA 340B registry, and claims validation tools. • Partner with external stakeholders, including state Medicaid agencies, 340B covered entities, and third‑party administrators, to determine the validity of disputes and ensure compliant resolution. • Serve as the subject matter expert on duplicate discount regulations, HRSA guidance, and industry best practices. • Review Quarterly Medicaid and State Supplemental Rebate invoices to confirm accuracy, timeliness, and compliance with contract terms. • Drive process optimization initiatives to increase accuracy, efficiency, and transparency in Medicaid contract operations. • Support audits, internal reviews, and compliance assessments related to Medicaid and 340B programs. • Monitor emerging federal and state policy changes that impact Medicaid operations and guide the team in proactive adaptation. • Maintain dashboards, analytical tools, and reports that provide insights into Medicaid and 340B trends, risks, and operational performance.

Job Requirements

  • Bachelor’s degree required; Advanced degree (MBA, MPH, etc.) preferred.
  • 5+ years of experience in Medicaid, government pricing, contract operations, 340B program management, or related pharmaceutical/healthcare fields.
  • Advanced Excel skills and knowledge of ModelN or a comparable rebate operation system.
  • Strong analytical skills with the ability to interpret large data sets and compile evidence, to accelerate dispute resolutions.
  • Strong knowledge of Medicaid Drug Rebate Program (MDRP), 340B program regulations, HRSA guidance, and state Medicaid operations.
  • Demonstrated experience leading operational teams in a matrix reporting structure.
  • High attention to detail, strong organizational skills, and ability to manage multiple priorities.
  • Excellent communication, influence, and problem-solving skills.
  • Ability to synthesis complex information and clearly communicate to leadership stakeholders.

Benefits

  • Medical, Dental, Vision, & Life insurances
  • Fitness & Wellness programs including a fitness reimbursement
  • Short- and Long-Term Disability insurance
  • A minimum of 15 days of paid vacation and an additional end-of-year shutdown time off (Dec 26-Dec 31)
  • Up to 12 company paid holidays + 3 paid days off for Personal Significance
  • 80 hours of sick time per calendar year
  • Paid Maternity and Parental Leave benefit
  • 401(k) program participation with company matched contributions
  • Employee stock purchase plan
  • Tuition reimbursement of up to $10,000 per calendar year
  • Employee Resource Groups participation

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