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.