[Hiring] Director of Contract Operations and Revenue Integrity @Otsuka Pharmaceutical Co., Ltd.

Role Description

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.

Requirements

• Minimum $186,489.00 - Maximum $278,875.00, plus incentive opportunity.
• This range 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.

Benefits

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