Director, Contract Operations & Revenue Integrity

Otsuka Pharmaceutical Co., Ltd.

2d • $186,489 - $278,875

About The Position

The Director, Contract Operations & Revenue Integrity oversees the financial execution, validation, and auditing of all commercial and government payer contracts. This critical role ensures financial accuracy, eliminates revenue leakage, and maintains strict compliance with internal policies and external regulations. You will lead a specialized team responsible for validating billions of dollars in rebate claims, managing payer disputes, processing payments, and executing rigorous external audits of payer customers to protect the company's gross-to-net (GTN) revenue.

Requirements

• Bachelor’s Degree required in Finance, Accounting, Business, or Healthcare Administration.
• 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.

Nice To Haves

• Advanced credentials preferred such as an MBA, CPA, CIA (Certified Internal Auditor), or MS in Finance.

Responsibilities

• Oversee validation processes for all 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 strict prompt-pay guidelines.
• Maintain financial systems integrity by ensuring accurate mapping of contract rules within institutional software.
• Ensure prompt and on-time payment with coordination with Finance and Treasury.
• Optimize revenue leakage by identifying overpayments, duplicate claims, and systemic processing errors.
• Lead the dispute management framework to resolve payment variances and data discrepancies with payers.
• Recover leakage funds through assertive, data-backed reconciliations and structured settlement negotiations.
• Track financial recovery metrics to proactively address and mitigate future revenue erosion trends.
• Direct external audit programs of payer customers to verify compliance with formulary exclusivity contracts.
• Manage internal and external compliance mandates, including SOX controls, government pricing audits, and corporate policies.
• Standardize audit protocols and risk-assessment matrices to determine which payer accounts require immediate investigation.
• Partner with Legal and Market Access Teams to enforce contractual remedies for non-compliant payer customers.

Benefits

• Comprehensive medical, dental, vision, prescription drug coverage
• company provided basic life, accidental death & dismemberment, short-term and long-term disability insurance
• tuition reimbursement
• student loan assistance
• a generous 401(k) match
• flexible time off
• paid holidays
• paid leave programs

What This Job Offers

• Job Type: Full-time
• Career Level: Director