Specialist, Contract Operations

Position Summary

The Specialist, Contract Operations is responsible for the operational oversight, implementation, governance, and lifecycle management of payer contract data, reimbursement methodologies, pricing structures, and system configuration requirements within specialty pharmacy systems.

This role exercises independent judgment and operational discretion in translating payer contract requirements into scalable operational and system-based solutions that support reimbursement accuracy, claims adjudication integrity, and downstream financial realization. The Specialist serves as a key operational resource supporting cross-functional contract implementation, pricing governance, reimbursement configuration, operational issue resolution, and data integrity management across all payer types.

Operating in partnership with Managed Markets, Reimbursement, Operations, Quality Assurance, Finance, and IT, this role is responsible for evaluating operational impacts, identifying configuration risks, resolving reimbursement-impacting discrepancies, and supporting operational decision-making associated with contract operationalization and payer implementation activities. The Specialist directly contributes to operational scalability, reimbursement integrity, governance compliance, and continuous process optimization initiatives supporting the organization’s long-term growth strategy.

Essential Functions and Duties

Contract Operations Governance & System Oversight:

• Lead operational implementation and lifecycle management activities associated with payer contract configurations, reimbursement methodologies, and pricing structures within specialty pharmacy systems
• Interpret payer contract requirements and determine appropriate operational and system configuration approaches to support reimbursement accuracy and downstream claims processing integrity
• Exercise independent judgment in evaluating operational dependencies, reimbursement impacts, and system configuration requirements
• Maintain payer mappings, reimbursement structures, pricing logic, and configuration elements required to support accurate claims adjudication and operational execution
• Review, analyze, and resolve complex operational discrepancies, configuration issues, and reimbursement-impacting data integrity concerns
• Recommend corrective actions and operational improvements to mitigate reimbursement risk and strengthen configuration accuracy

Contract Pricing Data Operations & Governance:

• Oversee recurring pricing update processes including monthly, quarterly, and ad hoc pricing maintenance activities across methodologies including AWP, ASP, WAC, NADAC, and payer-specific fee schedules
• Analyze pricing methodologies, reimbursement structures, and operational impacts associated with payer pricing configurations
• Retrieve, validate, interpret, and apply pricing data from external reimbursement and pricing sources including Redbook, RJ Health, Medicaid, and Medicare
• Exercise operational discretion in validating pricing logic, escalation prioritization, and reimbursement-impacting discrepancies
• Ensure pricing updates are accurately implemented across impacted systems and operational workflows

Contract Operationalization & Cross-Functional Coordination:

• Lead operational implementation activities associated with executed payer agreements and reimbursement structures
• Partner cross-functionally with Managed Markets, Reimbursement, Operations, Intake, Authorizations, Quality Assurance, Finance, and IT to support operational readiness and implementation alignment
• Provide operational guidance and recommendations regarding payer configuration requirements, reimbursement structures, implementation dependencies, and system readiness
• Independently prioritize implementation activities based on operational urgency, reimbursement impact, and downstream business dependencies
• Support operational decision-making associated with payer onboarding, reimbursement implementation strategy, and operational scalability initiatives

Operational Governance, Audit Readiness & Risk Mitigation

• Maintain audit-ready documentation supporting payer configurations, pricing updates, reimbursement structures, and operational changes
• Ensure all updates and configuration activities remain traceable, version-controlled, and aligned to governance and compliance standards
• Evaluate operational workflows, governance controls, and reimbursement processing dependencies to identify opportunities for operational improvement and risk reduction
• Identify operational risks, reimbursement-impacting discrepancies, and data integrity concerns requiring escalation or corrective action
• Support development and enhancement of governance controls, operational procedures, and scalable workflow standards

Process Optimization & Continuous Improvement:

• Evaluate operational processes and recommend workflow enhancements, automation opportunities, and system optimization initiatives
• Participate in operational planning and process improvement initiatives supporting scalability, reimbursement integrity, and operational efficiency
• Support implementation of standardized operational frameworks and repeatable control structures across payer and reimbursement operations
• Contribute to cross-functional initiatives focused on improving operational accuracy, reducing manual intervention, and strengthening reimbursement outcomes

General Responsibilities:

• Adheres specifically to all company policies and procedures, Federal and State regulations, and laws.

• Display dedication to position responsibilities and achieve assigned goals and objectives.

• Always represent the Company in a professional manner and appearance.
• Understand and internalize the Company’s purpose, display loyalty to the Company and its organizational values.
• Display enthusiasm and dedication to learning how to be more effective on the job and share knowledge with others.
• Work effectively with co-workers, internal and external customers and others by sharing ideas in a constructive and positive manner; listen to and objectively consider ideas and suggestions from others; keep commitments; keep others informed of work progress, timetables, and issues; address problems and issues constructively to find mutually acceptable and practical business solutions; address others by name, title, or other respectful identifier, and respect the diversity of our work force in actions, words, and deeds.

• Comply with the policies and procedures stated in the Injury and Illness Prevention Program by always working in a safe manner and immediately reporting any injury, safety hazard, or program violation.

• Ensure conduct is consistent with all Compliance Program Policies and procedures when engaging in any activity on behalf of the company. Immediately report any concerns or violations.

• Other duties as assigned.

Education, Knowledge, Skills, and Experience

Required Education:

• Bachelor’s degree in Business Administration, Healthcare Administration, Finance, Data Analytics, or a related field
• Equivalent professional experience may be considered in lieu of degree requirements

Preferred Education:

• Bachelor’s degree in a healthcare, finance, business, analytics, or operational discipline

Required Experience:

• Minimum four (4) to six (6) years of progressively responsible experience in healthcare contract operations, reimbursement operations, payer configuration, pricing governance, specialty pharmacy operations, managed care operations, or related operational environments
• Experience exercising independent judgment in operational implementation, reimbursement support, pricing governance, or contract operationalization activities
• Experience supporting cross-functional operational implementation, issue resolution, and workflow optimization initiatives

Preferred Experience:

• Experience within specialty pharmacy, healthcare reimbursement, managed care, or payer operations environments
• Experience supporting payer implementation, pricing governance, reimbursement analysis, or operational configuration activities
• Experience working within audit, compliance, governance, or operational control-focused environments

Required Knowledge:

• Strong understanding of payer structures, reimbursement methodologies, pricing logic, and operational configuration principles
• Knowledge of healthcare reimbursement processes, claims adjudication workflows, and specialty pharmacy operations
• Understanding of operational governance, data integrity controls, and audit readiness standards
• Knowledge of structured data management, operational workflows, and system configuration methodologies

Required Skills:

• Strong analytical and operational problem-solving capabilities
• Ability to exercise independent judgment and operational discretion within established governance frameworks
• Ability to evaluate reimbursement impacts, operational dependencies, and configuration risks
• Strong business acumen and operational decision-making capabilities
• Exceptional attention to detail and commitment to operational accuracy
• Strong written and verbal communication skills
• Ability to independently prioritize and manage multiple operational activities in a fast-paced environment
• Advanced proficiency in Microsoft Excel and operational reporting tools
• Ability to collaborate effectively across cross-functional operational and leadership teams

Preferred Skills:

• Experience with specialty pharmacy systems, ERP platforms, payer systems, or reimbursement platforms
• Exposure to automation initiatives, workflow optimization, or operational analytics
• Experience supporting operational governance, audit preparation, or reimbursement controls

Physical requirements

Vision, hearing, speech, movements requiring the use of wrists, hands and/or fingers. Must have the ability to view a computer screen for prolonged periods and the ability to sit for extended periods. Must have the ability to work the hours and days required to complete the essential functions of the position, as scheduled.  Must have the ability to lift and maneuver items of at least 50 lbs. Must have the ability to travel occasionally. Working condition include normal warehouse setting.

Mental Demands

Learning, thinking, concentration and the ability to work under pressure, particularly during busy times.   Must be able to pay close attention to detail and be able to work as a member of a team to ensure excellent customer service.  Must have the ability to interact effectively with co-workers and customers, and exercise self-control and diplomacy in customer and employee relations’ situations.  Must have the ability to exercise discretion as well as appropriate judgments when necessary.  Must be proactive in finding solutions.

Direct Reports

No

EEO Statement

FFF Enterprises and Nufactor are an equal opportunity employer and prohibits discrimination and harassment based on the following characteristics: race, color, religion, national origin, physical or mental disability, gender, age (40 years and over) qualified veteran and any other characteristic protected by state or federal anti-discrimination law covering employment. These categories are defined according to Government Code section 12920. The Company prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has or is perceived as having any of those characteristics.

Acknowledgement

The above statements are intended to describe the general nature and level of work being performed by the incumbent assigned to this classification.  They are not intended to be construed as an exhaustive list of all responsibilities, duties, and/or skills required of all personnel so classified. 

The undersigned employee acknowledges receipt of the Job Description for the employee’s position and understands the essential functions, responsibilities, and qualifications of the position.  Furthermore, the employee acknowledges that this Job Description does not include all the essential functions of this position, and that these essential functions may change as deemed necessary by the manager.