Director, Contract Operations & Revenue Integrity

Director, Contract Operations & Revenue Integrity 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. Key Responsibilities Rebate Validation & Payment Processing 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. Revenue Integrity & Dispute Management 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. Payer Auditing & Compliance 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. Qualifications 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. Competencies Accountability for Results - Stay focused on key strategic objectives, be accountable for high standards of performance, and take an active role in leading change. Strategic Thinking & Problem Solving - Make decisions considering the long-term impact to customers, patients, employees, and the business. Patient & Customer Centricity - Maintain an ongoing focus on the needs of our customers and/or key stakeholders. Impactful Communication - Communicate with logic, clarity, and respect. Influence at all levels to achieve the best results for Otsuka. Respectful Collaboration - Seek and value others’ perspectives and strive for diverse partnerships to enhance work toward common goals. Empowered Development - Play an active role in professional development as a business imperative. Minimum $186,489.00 - Maximum $278,875.00, plus incentive opportunity: The range shown represents a typical pay range or starting pay for individuals who are hired in the role to perform in the United States. Other elements may be used to determine actual pay such as the candidate’s job experience, specific skills, and comparison to internal incumbents currently in role. Typically, actual pay will be positioned within the established range, rather than at its minimum or maximum. This information is provided to applicants in accordance with states and local laws. Application Deadline: This will be posted for a minimum of 5 business days. Company 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 Other company provided benefits Otsuka is an equal opportunity employer. All qualified applicants are encouraged to apply and will be given consideration for employment without regard to race, color, sex, gender identity or gender expression, sexual orientation, age, disability, religion, national origin, veteran status, marital status, or any other legally protected characteristic. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation, if you are unable or limited in your ability to apply to this job opening as a result of your disability. You can request reasonable accommodations by contacting View email address on click.appcast.io. Otsuka does not accept unsolicited assistance from search firms for employment opportunities. All CVs/resumes submitted by search firms to any Otsuka employee directly or through Otsuka’s application portal without a valid written search agreement in place for the position will be considered Otsuka’s sole property. No fee will be paid if a candidate is hired by Otsuka as a result of an agency referral where no pre-existing agreement is in place. Where agency agreements are in place, introductions are position specific. Please, no phone calls or emails. Otsuka Pharmaceutical Co., Ltd. is a global healthcare company with the corporate philosophy: Otsuka-people creating new products for better health worldwide. In the U.S., Otsuka is comprised of two companies, Otsuka America Pharmaceutical, Inc., and Otsuka Pharmaceutical Development & Commercialization, Inc., that share a deep commitment to the development and commercialization of innovative products in the spaces of neuroscience, nephrology, and digital medicine. Driven by our purpose to defy limitation, so that others can too, we have an unwavering belief in doing more and transcending expectations. In going above and beyond—under any circumstances—for patients, families, providers, and for each other. It’s this deep-rooted dedication that drives us to uncover answers to complex, underserved medical needs, so that patients can push past the limitations of their disease and achieve more than they thought was possible each and every day. OPDC and OAPI are indirect subsidiaries of Otsuka Pharmaceutical Company, Ltd., which is a subsidiary of Otsuka Holdings Co., Ltd. headquartered in Tokyo, Japan. The Otsuka group of companies employed 34,400 people worldwide and had consolidated sales of approximately USD 14.2 billion in 2023. We invite you to explore our open positions for an opportunity to join our 2,200 colleagues in the U.S. whose passion for our mission and pride in our company have earned us certification as a Great Place to Work by the Great Place to Work Institute. #J-18808-Ljbffr Otsuka Pharmaceutical Co., Ltd