Specialist, 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 evaluates operational impacts, identifies configuration risks, resolves reimbursement‑impacting discrepancies, and supports 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.

• 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

• 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

• 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

• Maintain audit‑ready documentation supporting payer configurations, pricing updates, reimbursement structures, and operational…