Techno Functional SME - Medicaid

Role Overview

We are looking for a highly experienced Senior Techno-Functional Subject Matter Expert (SME) with 12+ years of experience in Medicaid systems, Medicaid claims processing and regulatory compliance. Model N Flex/ PbyN experience remains highly desirable along with SQL, PL/SQL and Cognos expertise.

This position plays a critical role in bridging business needs and technology, driving product implementations, integrations, and process transformations using platforms such as Model N , Revitas and modern cloud-based solutions.

Key Responsibilities

1. Business Analysis & Strategic Solutioning

• Lead end-to-end requirement gathering and stakeholder workshops across Commercial contracting and revenue management.
• Translate business needs into:
• Functional Requirements specification(FRS)
• Technical Design specification (TDS)
• Perform gap analysis and recommend optimized solutions aligned with business goals
• Partner with leadership to align strategic initiatives with IT transformation roadmap

2. SME – Pricing, Market Access & Revenue Management

• Act as Techno-functional SME for:
• Medicaid Rebates & Medicaid Claim Level detail (CLD) (primary)
• Government Pricing (secondary)

3. Product Implementation & Integration

• Drive implementation and configuration of:
• Model N Flex (primary)
• ModelN PbYN
• Lead integration design across:
• ERP systems
• Data warehouses
• Upstream/downstream pricing systems
• Ensure scalable, cloud-enabled architecture for Medicaid rebate solutions

4. Data Analysis & Business Insights

• Perform data analysis and validation using SQL / PL-SQL / Informatica
• Conduct financial impact assessments for pricing and contracting changes
• Identify trends, risks, and revenue leakage opportunities
• Support data-driven decision-making with actionable insights

5. Testing, Validation & Deployment

• Lead System Integration Testing (SIT) and User Acceptance Testing (UAT)

6. Stakeholder Collaboration & Leadership

• Act as a bridge between business stakeholders and IT teams
• Collaborate with cross-functional teams:
• Market Access
• Finance
• Compliance
• IT / Engineering
• Facilitate workshops to define business use cases and future-state processes

7. Innovation & Transformation

• Drive adoption of emerging technologies such as:
• Cloud-based platforms

• Identify opportunities for:
• Operational efficiency
• Cost optimization
• Process automation

Required Skills & Experience

✠Domain Expertise

• Deep expertise in:
• Medicaid rebates and CLD
• Government Pricing and Compliance
• Pricing & Market Access
• Strong understanding of pharmaceutical commercial and regulatory landscapes

✠Technical Skills

• Hands-on experience with:
• Model N (mandatory)
• Revitas
• Strong data skills:
• SQL / PL-SQL
• Informatica / ETL tools
• UNIX
• Experience working with Cloud platforms (AWS/Azure)

✠Functional Capabilities

• Requirement gathering and stakeholder management
• Gap analysis and solution design
• System configuration and implementation
• Testing (SIT, UAT) and validation
• Strong documentation and process modeling skills

Why Join Us?

You will join a mission-critical team where your work directly impacts profit margins and ensures compliance in a rapidly evolving regulatory environment. You'll have the autonomy to drive innovation and the tools to make a measurable difference in protecting the organization’s revenue integrity.