Director, Contract Operations – Revenue Integrity

🔥 14 hours ago

🇺🇸 United States – Remote

💵 $186.5k - $278.9k / year

⏰ Full Time

🔴 Lead

💹 Revenue Operations

👻 Ghost score 0%

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Otsuka Pharmaceutical Companies (U.S.)

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

💊 Pharmaceuticals

🏥 Healthcare

🧬 Biotechnology

Pharmaceuticals • Healthcare • Biotechnology

Otsuka Pharmaceutical Companies (U. S. ) is a prominent player in the pharmaceutical manufacturing industry, dedicated to creating innovative products for better health worldwide. The company comprises two main entities: Otsuka America Pharmaceutical, Inc. (OAPI), which is focused on commercializing Otsuka-discovered and in-licensed products in North America, and Otsuka Pharmaceutical Development & Commercialization, Inc. (OPDC), which specializes in the clinical development and global registration of innovative healthcare solutions, particularly in the field of neuroscience.

📋 Description

• Oversee validation processes for commercial, Managed Care, PBM, and Medicare/Medicaid rebate claims • Authorize complex utilization data validation against contractual terms and formulary positioning • Manage timely payment processing, ensuring data accuracy and adherence to prompt-pay guidelines • Maintain financial systems integrity through accurate mapping of contract rules • Coordinate prompt and on-time payments with Finance and Treasury • Identify overpayments, duplicate claims, and systemic processing errors to reduce revenue leakage • Lead dispute management to resolve payment variances and data discrepancies with payers • Recover leakage funds through data-backed reconciliations and settlement negotiations • Track financial recovery metrics and mitigate future revenue erosion • Direct external payer audits to verify compliance with formulary exclusivity contracts • Manage SOX controls, government pricing audits, corporate policies, and other compliance mandates • Standardize audit protocols and risk-assessment matrices • Partner with Legal and Market Access Teams to enforce contractual remedies • Lead a specialized team responsible for rebate validation, payer disputes, payment processing, and external audits

🎯 Requirements

• Bachelor’s Degree required in Finance, Accounting, Business, or Healthcare Administration • Advanced credentials preferred, such as an MBA, CPA, CIA (Certified Internal Auditor), or MS in Finance • 8+ years of experience in pharma contract operations, gross-to-net analytics, or revenue compliance • 4+ years of leadership experience managing validation analysts, auditors, or financial operations teams • Knowledge of commercial, Managed Care, PBM, and Medicare/Medicaid rebate claims • Experience with utilization data validation against contractual terms and formulary positioning • Experience with payer disputes, payment variances, and data reconciliations • Knowledge of SOX controls, government pricing audits, and corporate policies • Experience directing external payer audits and enforcing contractual remedies • Experience with financial systems and contract-rule mapping • Ability to work in the United States

🏖️ Benefits

• Comprehensive medical, dental, vision, and prescription drug coverage • Company-provided basic life insurance • Accidental death and dismemberment insurance • Short-term and long-term disability insurance • Tuition reimbursement • Student loan assistance • Generous 401(k) match • Flexible time off • Paid holidays • Paid leave programs • Incentive opportunity