Senior Manager, Contracts Operations & Quality Assurance

Why We Are - Who We Are: About FFF Enterprises What We Do - https://www.fffenterprises.com/company/what-we-do.html Job Title Senior Manager, Contracts Operations & Quality Assurance Department Operations - Specialty Pharmacy FLSA Class Exempt Salary Grade Revised Date 03.31.2026 Position Summary The Senior Manager, Contracts Operations & Quality Assurance as the accountable owner of the end-to-end contract-to-claim translation lifecycle, ensuring that payer contract terms, pricing methodologies, and reimbursement structures are precisely interpreted, rigorously implemented, and consistently realized in expected financial outcomes. This role establishes and enforces a formal governance and control framework between Managed Markets contract strategy and downstream operational processing, eliminating reliance on manual processes, fragmented ownership, and inconsistent interpretation. The position is responsible for translating all contract constructs and pricing logic into structured, system-ready requirements; ensuring accurate configuration and alignment within operational systems; and validating readiness prior to claim submission to safeguard reimbursement accuracy and financial performance. Operating at the intersection of Managed Markets, Operations, Reimbursement, Finance, IT, and Quality Assurance, this role functions as a critical control point for revenue integrity. The incumbent proactively identifies and mitigates sources of revenue leakage, reduces claim denials and operational rework, and ensures that negotiated contract value is fully realized. Through disciplined implementation, cross-functional alignment, and audit-ready processes, this role enables scalable, consistent, and defensible execution across NuFactor’s payer portfolio, including PBM, Medicare, Medicaid, and commercial contracts. Essential Functions And Duties Contract-to-Claim Translation Ownership: • Serve as the single point of accountability for translating payer contract terms into executable pricing and reimbursement logic across all payer types. • Convert contractual language, including fee schedules, percentage-based reimbursement structures, and payer-specific methodologies, to operationalize these requirements into a clear, structured system implementation. • Ensure consistency and accuracy in how contract terms are translated across all lines of business, payer variations, and contract amendments. • Eliminate ambiguity and reliance on undocumented knowledge by standardizing contract interpretation and translation practices. Contract Pricing Implementation And Oversight • Maintain ownership of pricing integrity across all payer contracts, ensuring methodologies such as AWP, ASP, WAC, NADAC, and MAC are applied accurately and consistently. • Oversee all pricing updates, including monthly, quarterly, and ad hoc changes, ensuring completeness, timeliness, and accuracy across systems and documentation. • Validate that pricing updates are correctly applied across all impacted contracts, including drug additions, HCPCS transitions, and payer-specific adjustments. Financial Alignment And Revenue Integrity • Evaluate contract implementation outcomes against expected reimbursement and margin performance to ensure alignment with financial objectives. • Partner with Reimbursement and Finance to analyze expected versus actual reimbursement and identify drivers of revenue variance. • Partner with Managed Markets to understand their financial modeling for new contracts, renegotiations, and pricing changes to on profitability and risk. • Identify, quantify, and mitigate risks to resolve pricing discrepancies, contract misinterpretation, and system misalignment that may result in incorrect reimbursement or margin erosion. Contract And Pricing Configuration Governance • Define and document business requirements for contract and pricing configuration within specialty pharmacy systems, ensuring accurate translation of pricing logic into system specifications. • Partner with IT to ensure system configurations are executed accurately while maintaining clear separation of duties between business interpretation and technical implementation. • Validate that all system configurations align with approved contract terms and pricing methodologies prior to activation. • Maintain complete documentation and traceability of all system-related implementation decisions to support audit readiness. Processing Validation And Control Framework • Establish and enforce processing validation standards to ensure that contract terms, pricing logic, and system configurations are accurate before claims are generated. • Design structured validation checkpoints that confirm correct pricing application, payer mapping, based on contract requirements. • Oversee Quality Assurance team to enable independent validation of system outputs while retaining ownership of implementation accuracy. • Reduce reliance on downstream correction by strengthening upstream controls and ensuring implementation readiness. Root Cause And Impact Analysis • Partner with Reimbursement on assessment of denials, underpayments, and reimbursement discrepancies to identify and reconcile system issues related to contract processing and pricing accuracy. • Conduct root cause analysis across contract processing, system configuration, and operational workflows to identify failure points. • Implement corrective actions that reduce denial rates, improve reimbursement accuracy, and prevent recurring issues. • Quantify financial impact associated with identified issues and communicate findings to leadership. Cross-Functional Governance And Alignment • Serve as the central coordination point across Managed Markets, Operations, Reimbursement, Finance, IT, and applicable stakeholders to ensure alignment on contract implementation. • Establish and reinforce clear ownership boundaries across functions to prevent scope drift and operational inefficiencies. • Facilitate cross-functional discussions to align on contract interpretation, pricing updates, system changes, and issue resolution. • Ensure that issues are directed to the appropriate functional owner to ensure proper accountability and governance is transferred. Process Standardization And Scalability • Standardize contract operational processes, pricing update protocols, and validation procedures to improve consistency and efficiency. • Identify and implement opportunities for system automation, integration, and technical process improvement in partnership with IT. • Identify and implement opportunities for reduction in manual, administrative-driven processes with structured workflows that support scalability and accuracy. • Support long-term scalability by developing repeatable, controlled implementation frameworks. Performance Monitoring And Reporting • Develop and monitor key performance indicators related to contract operational processing, including translation, systems, and quality assurance. • Provide structured quarterly reporting to leadership on integrity or quality assurance risks related to contract operational processing, and areas for operational improvements. • Track trends and performance metrics to support continuous improvement and informed decision-making. Documentation And Compliance • Maintain comprehensive and organized documentation of contract translation, pricing logic, system requirements, validation results, and change history. • Ensure all processes are audit-ready, traceable, and compliant with internal policies and regulatory standards. • Support documentation best practices by having clear, updated, standard operating procedures including evidence of contract processing and quality assurance. Required Education Education, Knowledge, Skills, and Experience • Bachelor’s degree in Business Administration, Finance, Healthcare Administration, Information Systems, or a closely related field. • In lieu of a degree, equivalent professional experience demonstrating advanced expertise may be considered. Preferred Education • Master of Business Administration (MBA) or a master’s degree in Finance, Healthcare Administration, or a related discipline. Required Knowledge • Familiarity with specialty pharmacy operations, pharmaceutical contracting structures, or health plans. • Working knowledge of specialty pharmacy systems or healthcare systems. • Understanding of data governance, audit frameworks, and internal control environments. Preferred Knowledge • Understanding of healthcare reimbursement methodologies, including PBM, Medicare, Medicaid, and commercial payer structures. • Knowledge of pricing methodologies such as AWP, ASP, WAC, NADAC, and MAC, and how they impact reimbursement outcomes. • Understanding of the contract-to-claim lifecycle and the relationship between contract terms, system configuration, and financial performance. • Knowledge of system-based pricing and claims processing logic within healthcare or specialty pharmacy environments. Required Experience • Minimum of five (5) to eight (8) years of progressive experience in managed markets, business development, reimbursement, pricing, or specialty pharmacy operations or similar function. • Basic demonstrated experience with contract terms and operational or system execution requirements. • Experience working cross-functionally across Finance, IT, and Operations to ensure accurate implementation and outcomes. Preferred Experience • Experience in specialty pharmacy, pharmaceutical distribution environments, health plans, and regulated environments in healthcare. • Experience in revenue integrity, pricing governance, or contract implementation functions. • Experience supporting system implementations or configuration governance initiatives. Required Skills • Advanced analytical and data reasoning skills, with the ability to assess pricing accuracy and reimbursement outcomes. • Strong ability to understand contractual language and translate it into structured, actionable requirements. • Exceptional attention to detail and commitment to accuracy, precision, documentation, and validation. • Strong cross-functional collaboration and stakeholder influence skills. • Strong Excel and data analysis capabilities. • Ability to operate effectively in high-complexity, high-impact environments with multiple priorities. Preferred Skills • Experience with data visualization tools such as Power BI or Tableau. • Experience with process improvement, automation, or workflow optimization initiatives. Required Professional Certifications • None. Preferred Professional Certifications • None. 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 20 lbs. Must have the ability to travel occasionally. Working condition include normal office 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 Yes 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. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**_ _**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Print Name Signature \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date To be considered for a position with FFF Enterprises, Inc, applicants must complete and sign the application. Employee Benefits Available for FFF Enterprises Team Members Employee Benefits Include • Medical Insurance • Dental Insurance • Vision Discount Program • Vision Insurance Plan • Health Savings Account (HSA) • Flexible Spending Account (FSA) • Dependent Care Flexible Spending Account • Employee Assistance Program (EAP) • Group Life and AD&D • Voluntary Supplemental Life Insurance Plans • Short Term Disability • Long Term Disability Income Protection • 401k Profit Sharing Retirement Plan - Discretionary Match • Discretionary Bonus • Supplemental Insurance Plans • Prepaid Legal/Identity Theft Plan • Paid Holidays/Vacation/Sick Days • Seven (7) Paid Holidays, Two (2) Week Vacation, Five (5) Sick Days, and One (1) Float Day for CA, NC, and TX All Other States Receive One Hundred Twenty (120) Hours of PTO • Tuition Reimbursement Program • Notary Services • Employee Referral Bonus • Vendor Discount Programs • Corporate Individual Travel Program (Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.)