Director, Contract Operations – Revenue Integrity

This is a fully remote position, open to applicants in United States.

📋 Description

• Supervise validation procedures for commercial, Managed Care, PBM, and Medicare/Medicaid rebate claims

• Approve intricate utilization data validation in accordance with contractual agreements and formulary positioning

• Ensure timely processing of payments, maintaining data accuracy and compliance with prompt-pay regulations

• Uphold the integrity of financial systems by accurately mapping contract rules

• Collaborate with Finance and Treasury to ensure prompt and timely payments

• Detect overpayments, duplicate claims, and systematic processing errors to minimize revenue loss

• Lead the resolution of disputes to address payment discrepancies and data inconsistencies with payers

• Recover lost funds through data-driven reconciliations and negotiation of settlements

• Monitor financial recovery metrics and take measures to prevent future revenue decline

• Oversee external payer audits to confirm adherence to formulary exclusivity agreements

• Manage SOX controls, government pricing audits, corporate policies, and other compliance requirements

• Standardize audit protocols and risk-assessment frameworks

• Collaborate with Legal and Market Access Teams to implement contractual remedies

• Lead a dedicated team focused on rebate validation, payer disputes, payment processing, and external audits

⛳️ Requirements

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

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

• More than 8 years of experience in pharmaceutical contract operations, gross-to-net analytics, or revenue compliance

• At least 4 years of leadership experience overseeing validation analysts, auditors, or financial operations teams

• Familiarity with commercial, Managed Care, PBM, and Medicare/Medicaid rebate claims

• Experience in validating utilization data against contractual terms and formulary positioning

• Proficiency in handling payer disputes, payment discrepancies, and data reconciliations

• Knowledge of SOX controls, government pricing audits, and corporate policy adherence

• Experience in directing external payer audits and enforcing contractual agreements

• Proficient in financial systems and contract-rule mapping

• Must possess the ability to work in the United States

🏝️ Benefits

• Extensive medical, dental, vision, and prescription drug coverage

• Basic life insurance provided by the company

• Accidental death and dismemberment insurance

• Short-term and long-term disability insurance

• Tuition reimbursement program

• Assistance with student loans

• Generous 401(k) matching

• Flexible paid time off

• Paid holidays

• Paid leave programs

• Opportunity for incentives