Senior Manager, Contracts Operations & Quality Assurance

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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 appl