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Director, Business Services (Medicaid Operations)

1 month, 1 week ago
United States
Full-time
Lead
Operations Manager
Project and Program Management
Apply Now
Model N

Model N

Model N provides cloud-based revenue management software solutions specifically designed for the high technology and life sciences industries, enabling businesses to optimize their revenue processes and enhance their financial performance.

Professional Services
251-1K
Founded 1999
View All Jobs 5

Description

  • Own and improve delivery processes and outputs to ensure a positive client experience and clear service value.
  • Lead review and approval of Medicaid rebate deliverables to ensure quality, accuracy, compliance, and SLA adherence.
  • Oversee setup and maintenance of customer contracts and data management in Model N systems.
  • Serve as the Medicaid subject matter expert on processing and contracting, establishing best practices and sharing guidance with stakeholders.
  • Monitor regulatory changes and drive needed process and system updates to support compliance.
  • Partner with states to resolve disputes and improve rebate savings through claims-level validation analysis.
  • Lead, coach, and develop a high-performing Medicaid operations team with a focus on accountability, collaboration, and continuous improvement.
  • Manage strategic client relationships and act as the senior escalation point for inquiries related to processing, reconciliation, discrepancies, and payment status.
  • Collaborate with pricing, GTN, and product teams to support system enhancements, including AI and automation initiatives.
  • Ensure SOC controls and internal procedures are followed across the function.

Requirements

  • Bachelor’s degree in accounting, Finance, Business, or a related field.
  • 10+ years of experience in the pharmaceutical industry with Medicaid agreements.
  • Experience leading teams and managing client relationships.
  • Proven people leadership experience with the ability to coach, develop, and set clear expectations for high-performing teams.
  • Demonstrated ability to lead through change and drive process improvement and operational transformation.
  • Experience with Medicaid rebate systems and recognized subject matter expertise in Medicaid rebates.
  • Experience working in a mandated deadline environment and managing multiple client assignments.
  • Ability to understand complex government compliance requirements and apply them daily.
  • High accuracy, strong attention to detail, analytical skills, and ability to produce client-ready deliverables for executive audiences.
  • Technical ability to understand underlying data structures and work with large amounts of data.
  • Experience maintaining compliance with applicable regulatory, legal, and operational rules and best practices.
  • Demonstrated experience using generative AI tools such as ChatGPT, Copilot, Claude, or Gemini to improve productivity or problem solving.
  • Advanced proficiency in Microsoft Office, especially Excel, PowerPoint, and Word.
  • 10-20% travel required.

Benefits

  • Unlimited PTO for salaried employees.
  • Comprehensive medical, dental, and vision coverage.
  • Health Savings Accounts and Flexible Spending Accounts.
  • 401(k) with company match.
  • Volunteer Time Off (VTO).
  • Life and pet insurance.
  • Employee Assistance and Mental Health Programs.
  • Professional coaching and career development.
  • Base salary range of $150,000 to $195,000.

Interested in this position?

Apply directly on the company website

Apply Now

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